Doctors Don’t Agree on the Role of NPs

np

I turns out that I am NOT the only one complaining about the role of NPs.  Just to reiterate, I do believe there is a collaborative role for them just NOT a competitive one.  They are less educated and less trained (LELT) and they cannot replace doctors.  In the May 16 issue of the New England Journal of Medicine, the authors of a study were surprised at how far apart doctors and nurse practitioners were in their opinions.  Nearly 1,000 doctors and nurse practitioners surveyed were most divided on the question of who gives the higher quality of care: Two-thirds of physicians said if a doctor and nurse practitioner provided the same service, the doctor would do it better. Only a few nurse practitioners agreed with that.   A few!   Also 82 percent of NPs felt nurse practitioners should lead their own practices but only 17 percent of doctors did.  This magnitude of difference is massive.  Here is the best one.  Sixty-four percent of NPs said they should receive the same pay as physician for the same care while only 4% of physicians agreed.  Same pay!  I thought NPs were the cheaper option?

Here are some other tidbits of crap from this Health Day article with my thoughts in parenthesis:

  • On paper, it makes sense to expand the role of nurse practitioners in primary care because their education and training is shorter — an average of six years versus 11 or 12 years for doctors, including residency training. By some estimates, anywhere from three to 12 nurse practitioners can be educated for the price of producing one doctor.  (Our 11 or 12 years is like 25 of theirs.  They don’t do the hours we do in training.   And because they are cheaper to educate means nothing).
  • Donelan said there also is evidence that nurse practitioners do just as well as doctors when it comes to primary care — and that patients needing urgent care actually give nurse practitioners better marks on communication. (The evidence is with simple things like sore throats.  A monkey can score high on some of those things.)
  • But what is not known, she said, is how well nurse practitioners measure up against doctors when things get more complicated, such as in cases in which a patient’s diagnosis is unclear or a patient has multiple chronic health conditions. In those cases, Blumenthal said, “there’s no literature as to the superiority of one profession over the other.” (Once again, I told you that evidence that docs do things better than NPs will be hidden.  Read this post here where family docs do better in diabetes care than NPs)

Doctors need to protect their turf and their role.  Doctors need to protect patients.  The training and experience is not the same.   It is not politically incorrect to fight back.  It is the right thing to do.   Remember, the NPs started as a way to be collaborative.  Now they want to be competitive.  Game on.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  10 comments for “Doctors Don’t Agree on the Role of NPs

  1. Donna
    May 22, 2013 at 11:14 pm

    We’re not trying to take your jobs, doctors. The focus is WELLNESS, good outcomes, and patient satisfaction. I’ve spent long hours learning, and if I’m “stuck” need help, need opinons, etc., I call my collaborating MD. I am a pain management practitioner working in a community hospital. I do med management, and I have to say that I have YET TO FIND an MD other than my collaborating double boarded Pain/Anesthesia MD that can match what I know. Most healthcare MDs and nurses are taught zip about pain. Wise up! We don’t want your jobs, we want collaboration!

    • Doug Farrago
      May 23, 2013 at 6:41 am

      Tell your NP organization (https://authenticmedicine.com/?p=2965). You are out of touch with what is going on with them. Also, I will let the pain specialists who read this debate your “YET TO FIND” statement. As far as primary care goes, the education and training isn’t e even close. And it is insulting to insinuate that it is.

  2. mamadoc
    May 22, 2013 at 9:17 pm

    Even the best trained midlevels do only 6000-7000 hours of training and education. A residency trained FP has had over 20,000 hours of training. Guess which one I want taking care of me or my loved one?

  3. Doug Given MD
    May 22, 2013 at 6:39 pm

    I have worked with NPs, and for the most part they are pretty good. However, they do not have nearly the training of a physician and cannot do the complex decision making, dx, and treatment that physicians have to frequently render. I do family medicine and ER medicine. When you have the really bad illnesses, you need a physician.

  4. michael
    May 22, 2013 at 12:48 pm

    I teach nursing students, and believe me, the way we run them through their training is a crime. The emerge without any sort of residency, and are trained to think they are equal to MD’s. And, it is even worse for PA’s who really have swollen heads with even less training.
    NPs are great at looking at what is normal vs not and referring on what needs further work. Also those NPs who have been working for 20 years are generally very competent practitioners who have gained through experience the right to have more responsibility.

  5. Janet Ditto
    May 22, 2013 at 12:44 pm

    As a Physician Assistant, I am angered that the NP role is showing so much arrogance. I appreciate the physicians I work with, but as PAs, we are tied to a working relationship with a physician, which I deeply appreciate. I was BSN/ RN and went the PA route for many reasons 30 years ago as I saw this coming.

  6. Stacy RN
    May 22, 2013 at 11:34 am

    Agreed. And I see those physicians that have become dependent on NPs in their offices losing some of those skills I want in a doctor. They stop digging deeper when things don’t add up with the simple diagnosis, or they go too far when the simple diagnosis is the right diagnosis. And that’s what an NP does. Docs are docs and NPs are NPs. And that, kiddies, is why I’m out of this field. Can’t take the crap anymore. (But don’t expect me to fade away from these discussions. I’d miss you all too much! Guess I’ll start posting as “Stacy former-RN”? Unless you all have a better suggestion for my new non-nursing screen name…)

  7. Denise
    May 21, 2013 at 11:49 pm

    Ray – I was misdiagnosed – and I don’t think it was a difficult diagnosis at all – by both an NP and a PA in an office in which the doctor refused to see me despite several requests. It’s not an experience I want to repeat. I will never again agree to be seen by either except under the direct supervision of a doctor that I have access to.

    So as a patient I’m in full and rather passionate agreement that NPs don’t have the training or skills to act as physicians. However, in making this argument I suggest you focus less on the rewards you feel you deserve in return for your sacrifices. The best reason for limiting their scope of practice is the interests of patients, not the protection of doctors’ turf, income or exalted position.

    Of course I’m sure that’s what you really meant.

  8. Pat
    May 20, 2013 at 9:56 pm

    Back in FP residency I did a lot of OB. I know some residents who did fellowships to become OB/stat-C-section qualified, which never made any sense to me. I’ve never had a complicated delivery, but I’ve seen a few and have learned that if the picture is going bad, you need a real OB in the room right damn now! Some of you will disagree, but I’ve always thought that if one wanted to take the time and trouble to acquire an OB’s skills, well, they should just do the residency. And that’s how I see NP’s who think they can do my job.

  9. Ray
    May 19, 2013 at 9:36 pm

    Agreed! The reason you are called “physician” should mean something. Years of training, sacrifice, hospital work, residency, countless hours of patients care, learning… and just plain suffering “remember the saying…all the good cases happen in the middle of the night”, . Only to be compared to a practitioner with minimal training, who treats the most mundane of conditions. Give me a freeking break! If you want to be a doctor…then pay the price! The price is….. at least 8 years of college. Including 4 years medical school. Then….at least 3 years of residency. Don’t forget the residency. It is the most important part. It consists of 80-110 hours weeks of gruelling medical training that sometimes/frequently brings the practitioner to the brink. Accept no substitute……demand the best! Remember…you don’t know what you don’t know. Unfortunately ….the public does not know. They call these “practitioners” …”doctor”. Shame on you.

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