Humble Beginnings: What Can a PA or NP Do for Your Practice?

I’m sure there will be some who think I am anti-nurse, anti-NP from some recent posts critically reviewing information/position statements put forth by the American Association of Nurse Practitioners (AANP). I can assure you I am not. As I graduate medical school this month, I reflect back on my 15 yrs as a registered nurse (RN) and 8 yrs as a Psychiatric NP prior to starting med school. I’m humbled. It is especially fitting as it is currently National Nurses Day/Week, and I find myself thanking RNs and NPs all day. They say to never forget where you come from. I have bore witness to the notion of distinguishing yourself in the nursing profession. It was ACLS, it was specialty certification such as CCRN (Critical care RN) or RN-BC PMH (American Nurses Credentialing Center Board Certification for Psych Mental Health RN). The latter even got me a hefty bonus in the US Army while I was on active duty. Then came the Advanced Practice RN (APRN) of which there were mainly NPs, Clinical Nurse Specialists, Nurse Midwifes, and CRNAs (certified RN anesthetists – NOT anesthesiologists, as some will have you call them today). APRN became the next tier to distinguish oneself. Then came the push for PhD and DNP (Doctor of Nursing Practice). Now the push is for full practice authority for NPs. This is where I step off and tell my former profession to “hold up,” slow down, you’re starting to step on toes of other professions. It was all fine for me when it was kept within the nursing profession, which with all the advances and hard work I’ve seen, I have the utmost respect. However, I’m not for stepping on toes and going outside my proverbial lane. I don’t support NP full practice authority and I believe in Physician lead multi-disciplinary healthcare teams. Heck, I’m still licensed as an APRN though I’ll be an MD in mere weeks, so I believe I can still say this with credibility. I’ve walked on both sides of the asile. It is times like this that I reflect back to my roots and try to stay humble. I still remember receiving my acceptance letter to my Bachelor of Nursing (BSN) program in 1992 – yes, I started med school in my 40s (after ‘retiring’ from the US Army). I would urge my former profession colleagues to also on this day reflect back on individual careers and try to remain humble. With so much angst and animosity going on amongst NPs and MDs, I think my former profession has lost some of it’s humility. I see so much defensiveness. I believe it is the majority of both RNs and NPs that are on the front lines doing good and wonderful work, but this is being overshadowed by a zealous few. As a member of my former profession, let me apologize on their behalf and urge other professions to acknowledge the good ones that are out there. Thank a CNA (certified nursing assistant), thank an RN, thank an NP that you believe is doing good and making a difference this week. Trust me MDs, a simple thank you goes a long long way. Also, see the referenced article: “What Can a PA or NP Do for Your Practice?.” Disregard the nurse zealots and know that utilized correctly, APRNs can add value to MD led multidisciplinary healthcare teams. I may be leaving my former profession, but I never forget where I come from. Thank you.

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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  2 comments for “Humble Beginnings: What Can a PA or NP Do for Your Practice?

  1. Karen
    May 11, 2019 at 2:25 pm

    So you haven’t worked a day as an MD, but you think that APPs should be supervised by them?

    Clever.

    Get back to me when you show peer-reviewed evidence which says that outcomes are worse when provided by unsupervised APPs.

    It matters not one twit if another profession ends up with sore toes; the delivery of healthcare is not about them, it is about the patients, and physicians (collectively) are failing to deliver. The concept of exclusive physician practice is valid and sound, but there simply aren’t enough of them and that is not the fault of patients or APPs. APPs are stepping in the gap and expanding care with good outcomes and HUMILITY. NPs have not lost humility, they have instead read op-ed after article after blog post by physicians misrepresenting the issue, telling outright lies, using anecdotes, and avoiding evidence as they repeatedly malign APPs. It is not a loss of humility when NPs defend themselves. It is merely criticism of the pattern of hypocrisy by physicians who use anecdotes to malign NPs when those same anecdotes apply directly to physicians. Those NPs are not zealots; they are rational people responding to inappropriate attacks.

    The issue is not one of the ego of APPs, it is about the ego of physicians. The rest of the healthcare establishment has been kissing the a…. of physicians for decades. Segregated lounges and dining rooms staffed with aproned attendants. Designated parking spaces. Tolerance of hostile behavior. As a general rule, APPs are not attacking physicians, but many characters in the medical establishment are directing focused attacks on non-physician practitioners, almost always focusing on (and misrepresenting) the issue of education rather than patient access and outcome.

    I’m not sure what you think is going to happen when APPs step into the gap and are then systemically misrepresented and attacked by physicians. States are looking around for physicians to increase access for their population and they are either nowhere to be found or profoundly unaffordable. If they are not part of the solution, then they have no qualification to criticize the way other people solve the problem.

    The only two things that matter are access and outcome. The minute a physician steps out of that lane, they should not be disturbed by the backlash.

    • robert p duprey
      May 12, 2019 at 7:14 pm

      “When the debate is lost, slander becomes the tool of the loser.”

      ― Socrates

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