Response to "Nurse Practitoners cannot provide the same care as physicians:
"Nurse practitioners cannot provide the care of physicians," printed August 1, 2014:
Although James Bonds is entitled to his opinion, the research is widely available and actually confirms that the quality of care delivered by Nurse Practitioners (NPs) when compared to primary care physicians is as good or better. Please go to http://www.aanp.org/publications/position-statements-papers for a summary of 19 peer reviewed studies from 1977-2008 confirming primary care patient outcomes that are comparable and in some cases exceed that provided by their physician counter-parts.
I am not saying that an NP's education, training, and experience are equal to a physician's. Medical school encompasses every setting in which medical care is required, whereas NP programs are population specific. Primary care NPs do not have the skills or training to manage acutely ill patients who are unstable, such as in the emergency room or critical care. Conversely, an acute care NP would be capable of managing such patients, but her program lacks the educational preparation to manage the primary care patient.
Although it is true that Nurse Practitioner (NP) programs are only two years instead of four required by medical school, NP program applicants must have practiced as a registered nurse for a minimum length of time, generally two years before they are eligible to apply. So although Bonds is technically correct in asserting the NPs relative inexperience, most NPs have practiced nursing many years prior to entering their NP program. One could certainly make the case that nursing is not the same as the practice of medicine, however it is also not the same as no experience, which is the impression one might get from his comment. It is also true that physicians have the benefit of experience gained from their residency, which the NP lacks. As NP programs grow, they too will likely include a residency type training component to their programs. In the meantime, the new NP is indeed dependent on both her physician and more experienced NP and Physician Assistant (PAs) colleagues to provide the clinical judgment that can only be gained by practice, much like the physician resident.
In primary care, both NPs and physicians are required to have a broad base of medical knowledge and follow standards of evidence based care. Both refer complicated patients or patients that require a higher level of care to specialists such as oncology, cardiology, gastroenterology, etc. Do NPs refer more frequently or for less serious conditions than physicians? Absolutely not. Anyone with any healthcare consumer experience knows a referral is subject to the same scrutiny by the payer (insurance) regardless of who makes the referral.
Although I believe it would be a dis-service to replace every primary care physician with an NP or Physician Assistant, perhaps we should be asking if the primary care physician shortage is really a shortage. Does it take 7-8 years of training to provide quality care to the vast majority of patients seen in primary care? Wouldn't it make more sense to use our primary care physicians as resources in practice, instead of requiring one for every patient?
Now before I start a turf war, let me just say that I am eternally grateful to my physician colleagues who have generously shared their knowledge and clinical expertise with me, especially during my first years as an NP. I continue to rely on my supervising physician to direct me when I encounter something outside the range of my experience. Consider this: when you see an NP, you potentially have access to her supervising physician's knowledge, experience, and judgment as well. More for less, you might say.
Stacy Varley, Family Nurse Practitioner
Submitted to the Eagle 08/03/2014