The MD Bias Hits Home

Updated | Posted
by JBMmom JBMmom, MSN, NP Member Nurse

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 10 years experience.

supporting-doctors-over-nurse-practitioners.jpg.0d27a91ec158737e0809588b61ed6d6a.jpg

I just started a hospitalist position in January, doing night cross-coverage. I am scheduled to come off orientation in a few weeks. On my way into work last week there was a conference call meeting and we were told that our position is being eliminated. This affects only 4 NPs in our group, and we are being offered a position 11am-11pm instead (two additional NPs already work 11-11). Instead of being a more autonomous position, the 11-11 position is basically being parsed out work by the MDs as they see fit. 

After the meeting, one of the other NPs was working nights and heard from numerous staff members that this came about because one of the very vocal docs put forth that "as an acute care facility we should be staffed solely by MDs". So they're going to have 4 MDs instead of 4 NPs. The nurses on the floor are very upset because we are known as a group to be very responsive, coming to see patients quickly and responding to our texts in a timely manner. When someone calls out and cross coverage is done by the MDs, it's typically more difficult for the nurses to get timely responses.

Coming into a large teaching hospital I knew that the focus would be the medical staff and we're mainly support. But this is really disappointing because we had no input in this decision and it just emphasizes the "us vs them", instead of the organization supporting us NPs as professionals and encouraging the MDs to work with us, they just go with it. 

Instead of starting my career, five months in I'll be looking for a new job again. I'm going to try to stay within the organization because the benefits are really exceptional. I'm hoping a different group may treat the NPs as professionals deserving of respect. We'll see what happens. 

Hoosier_RN, MSN

Specializes in dialysis. Has 29 years experience. 3,561 Posts

So sorry that you're dealing with this. I'll cross my fingers that something great will come along for you. (((HUGS)))

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience. 1,608 Posts

I'm sorry you're going through this as well.  The "us vs. them" attitudes of some MDs towards NPs are so tiresome.  The American healthcare system is an absolute hot mess, and simply cannot sustain its current trajectory.  We spend way too much and have little to show for it.  Because MDs are socialized to see themselves as the top of a hierarchy, many cannot comprehend a reality where they are not the sole provider profession.  

I'm a CNM and studies show time and time again that we provide better care to the majority of women, with better outcomes at a lower cost to the healthcare system, we're the ones fighting to be viewed as legitimate providers and not witch doctors.  Same for you--you're providing what I assume is solid care with stronger relationships with the floor nurses, which only benefits the patients.  Yet you're the ones getting fired.  

The good news is there are many settings and institutions that do value APRNs, and I hope you are able to move on to something better and brighter!

ThePrincessBride, MSN, RN, NP

Specializes in Med-Surg, NICU. Has 7 years experience. 1 Article; 2,579 Posts

This is one of the reasons why I do not want to work as an NP for a teaching state hospital as NPs are treated like assistants and not autonomous professionals. 

JBMmom, MSN, NP

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 10 years experience. 4 Articles; 2,214 Posts

On 6/13/2022 at 4:57 PM, Hoosier_RN said:

So sorry that you're dealing with this.

On 6/14/2022 at 11:02 AM, LibraSunCNM said:

The "us vs. them" attitudes of some MDs towards NPs are so tiresome.

On 6/14/2022 at 11:14 AM, ThePrincessBride said:

NPs are treated like assistants and not autonomous professionals.

Thanks everyone. I'm sure that something will work out. And I know that in a way I was complaining but then I'm going to settle at the same time. I've got two kids headed into the college years (senior and sophomore in high school) and this position includes tuition waivers for our state school, AND in 15 years I'm eligible for a full retirement with pension and medical benefits. I'm old enough now that my principles have to bend just a little in the best interests of my family and future. But this particular position clearly isn't going to fit that at all. There are definitely groups within the hospital that have autonomous NPs that are respected, I'm hoping to land in one of those. Appreciate the support!

2BS Nurse, BSN

Has 9 years experience. 675 Posts

I recently moved to Occupational Health and I love it. I am working with NPs as providers and they are awesome! 

"I'm eligible for a full retirement with pension and medical benefits".

These seem to be the only nurses remaining in their positions. The ones who lack pensions (and dislike their jobs) have no incentive to stay. We all have to do what's best for our families.

Tegridy

Tegridy

Specializes in Former NP now Internal medicine PGY-3. 427 Posts

On 6/13/2022 at 12:37 PM, JBMmom said:

supporting-doctors-over-nurse-practitioners.jpg.0d27a91ec158737e0809588b61ed6d6a.jpg

I just started a hospitalist position in January, doing night cross-coverage. I am scheduled to come off orientation in a few weeks. On my way into work last week there was a conference call meeting and we were told that our position is being eliminated. This affects only 4 NPs in our group, and we are being offered a position 11am-11pm instead (two additional NPs already work 11-11). Instead of being a more autonomous position, the 11-11 position is basically being parsed out work by the MDs as they see fit. 

After the meeting, one of the other NPs was working nights and heard from numerous staff members that this came about because one of the very vocal docs put forth that "as an acute care facility we should be staffed solely by MDs". So they're going to have 4 MDs instead of 4 NPs. The nurses on the floor are very upset because we are known as a group to be very responsive, coming to see patients quickly and responding to our texts in a timely manner. When someone calls out and cross coverage is done by the MDs, it's typically more difficult for the nurses to get timely responses.

Coming into a large teaching hospital I knew that the focus would be the medical staff and we're mainly support. But this is really disappointing because we had no input in this decision and it just emphasizes the "us vs them", instead of the organization supporting us NPs as professionals and encouraging the MDs to work with us, they just go with it. 

Instead of starting my career, five months in I'll be looking for a new job again. I'm going to try to stay within the organization because the benefits are really exceptional. I'm hoping a different group may treat the NPs as professionals deserving of respect. We'll see what happens. 

MDs are harder to replace since NPs are a dime a dozen now. Doesn’t really matter who is right, just who is harder to replace. I do not know who is right since there are no details. Likely whoever made the decision got tired of hanging liability on his/her license.

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 30 years experience. 9 Articles; 4,338 Posts

Without knowing the details, I agree that there is more nuance to the MD vs NP debate. Where I work, it's easier to hire MD's for nocturnal hospitalist coverage.

There are many graduates of IM residencies who prefer to do a year of nocturnal hospitalist employment while waiting for their desired fellowship. It creates a steady stream of trained providers ready to assume the role. NP's are larger in number in terms of the available pool of applicants but finding that NP who can hit the ground running is harder because most likely, the NP hired would require a period of orientation (which will take weeks) instead of an MD that can practice right away. 

There are niche specialties where the bang for the practice's buck will depend on hiring a group of NP's to work alongside a group of MD's. Critical Care seems to be a perfect example where you can train a group of NP's in doing procedures and following protocols for medical management with minimal supervision from MD's. It also creates a revenue stream because Critical Care requires independent billing.

Tegridy

Tegridy

Specializes in Former NP now Internal medicine PGY-3. 427 Posts

2 hours ago, juan de la cruz said:

Without knowing the details, I agree that there is more nuance to the MD vs NP debate. Where I work, it's easier to hire MD's for nocturnal hospitalist coverage.

There are many graduates of IM residencies who prefer to do a year of nocturnal hospitalist employment while waiting for their desired fellowship. It creates a steady stream of trained providers ready to assume the role. NP's are larger in number in terms of the available pool of applicants but finding that NP who can hit the ground running is harder because most likely, the NP hired would require a period of orientation (which will take weeks) instead of an MD that can practice right away. 

There are niche specialties where the bang for the practice's buck will depend on hiring a group of NP's to work alongside a group of MD's. Critical Care seems to be a perfect example where you can train a group of NP's in doing procedures and following protocols for medical management with minimal supervision from MD's. It also creates a revenue stream because Critical Care requires independent billing.

yes night shift is my goal if I don't match GI, which since its GI nothing guaranteed. pays so much more and honestly prefer it to days. and its what I did as an NP. except nocturnist physician jobs pay like 4x as much in my area as night NPs. No social work junk, no admin, etc. 

 

But back on the post yes I don't think we can pass judgement without knowing the details. 

JBMmom, MSN, NP

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 10 years experience. 4 Articles; 2,214 Posts

Thanks everyone, not really asking anyone to pass judgment here, was just posting out of frustration. I'm sure there's more to the story that I won't ever even know. Maybe this one doctor has no administrative power at all and it's just a coincidence that he's made comments to other staff and then our positions were eliminated. But it's the frustration of knowing that someone in authority is telling other staff that coworkers don't belong there. While I'm new to the group, my coworkers that have worked in these positions 10+ years have provided competent, patient centered care. I'm certainly not saying I'm perfect but I've had great feedback from my staff nurses about being responsive and helpful since I've started. It's just disappointing because I was really planning on 4-5 years in this position to focus on improving my patient care skills and knowledge base.  

Hoosier_RN, MSN

Specializes in dialysis. Has 29 years experience. 3,561 Posts

18 hours ago, JBMmom said:

Thanks everyone, not really asking anyone to pass judgment here, was just posting out of frustration. I'm sure there's more to the story that I won't ever even know. Maybe this one doctor has no administrative power at all and it's just a coincidence that he's made comments to other staff and then our positions were eliminated. But it's the frustration of knowing that someone in authority is telling other staff that coworkers don't belong there. While I'm new to the group, my coworkers that have worked in these positions 10+ years have provided competent, patient centered care. I'm certainly not saying I'm perfect but I've had great feedback from my staff nurses about being responsive and helpful since I've started. It's just disappointing because I was really planning on 4-5 years in this position to focus on improving my patient care skills and knowledge base.  

Believe me, when one door slams in your face, a door to a better room opens. You're going to come out of this in a better position than you could imagine

MentalKlarity, BSN, NP

Specializes in Psychiatry. Has 9 years experience. 252 Posts

Unfortunate and unfair, but yea things like this will be more common as long as number of graduating NPs stays so high each year and schools churn out record numbers. It makes NPs less desirable and easier to replace.