A Nurse Practitioner's View

"Hey, How are you doing today?" This is supposedly the way that many nurse practitioners (and physician assistants) introduce ourselves to patients according to Gary Larkin, M.D. who recently conducted a study published in the American Journal of Bioethics entitled, "Patient willingness to be seen by physician assistants, nurse practitioners, and residents in the emergency department: Does the assumption of assent have an empirical basis?" This study is a thinly veiled turf attack on both nurse practitioners and physician assistants. From the beginning of the article, the authors write: "...physician substitution has often been covert in the emergency department (ED), confusing patients as to provider identity and appropriate scope of practice. This confusion may be heightened as junior doctors and nonphysician clinicians alike wear the same long white coats and Littmann stethoscopes as experienced physicians." I retrieved the article myself to unde...

With the passing of the recent historic health insurance reform, the focus has turned (see here and here and here ) to how will the system deal with the influx of approximately 31 million newly insured seeking access to care. All of these articles address the current shortage of primary care physicians in some way and creates a sense of urgency for patients to try and secure one before access becomes crippled (as it has in Massachusetts). What these articles fail to address is the true potential that NPs and PAs have to pick up this slack. There is this incorrect assumption that NPs, facing the same barriers in primary care, are flocking to lucrative specialties. Fortunately for patients, this is not the case. A recent survey by Advance for Nurse Practitioners, reveals that most of the NPs polled work in predominantly primary care or primary care-type settings. Also a very informal survey of the NPs that I know has a similar result. So what does all this mean? The good news is that ...

I have tried to refrain from taking the bait from some recent negative opinions regarding nurse practitioner delivered care. Quite frankly, the arguments are old and tired. My goal as a clinician is to deliver the highest quality, evidence-based, and culturally competent care that I am capable of. I refuse to pit NPs versus other professions. We all have our own slightly varied philosophies and approaches to delivering care. Some may prefer the approach of a DO while some choose to see a NP or PA or MD. I believe patients have that right. However, I cannot believe the nonsense and out of context rubbish posted on the AMA's "Virtual Mentor" in a column entitled, " The Primary Care Shortage, Nurse Practitioners, and the Patient-Centered Medical Home. " Oh, where to begin! The opinion piece begins with the patronizing idea that NPs are part of the solution but not THE solution to the primary care crisis in this country. Funny, but I couldn't find a single ref...

An article about physician assistants and nurse practitioners appears in the NY Times Jobs section. The article does a very good job of explaining both professions though I would disagree with a few of the statements. Another important difference is that P.A.’s are generalists, while nurse practitioners train in a specialty like family medicine or women’s health. As a result, P.A.’s can switch fields more easily . - I would say that isn't necessarily true. Since the majority of NPs are trained in family health, I think it's just as easy for these FNPs to transition into different roles. To patients, the two roles can seem very similar. Salaries can be similar, too. The average total income for physician assistants in full-time clinical practice is about $86,000, according to the P.A. academy. The average total income for nurse practitioners is $92,000. - average salary of $92k? I think that sounds pretty high. Most of the NPs that I know are in the $70 - $90k range and I ...

Here is a link to a Medical Economics column, " How I built a successful medical practice in under seven years." What struck me about the article is Dr. Kurt Hunter, a Wyoming physician, and the utilization of physician assistants (a total of 4) in his practice. Each PA sees about 40 acutely ill patients daily, and I see the more complicated cases—usually about 15 per day, with visits lasting 20 to 40 minutes. This sounds like a perfect scenario and a true team-oriented approach to primary care in this community. The physician should be taking on the more complex cases leaving the more routine cases to the PAs (though we all know, nothing is routine). Not surprisingly, other physicians in the blogosphere have criticized him for "giving away primary care to mid-levels" which just shows the stubborn mindset of some. According to the article, Dr. Hunter was also integral in supporting Wyoming legislation that increased the number of PAs that he can directly work with ...

This is classic. On his blog, DB's Medical Rants, Dr. Bob, writes the following about the term 'primary care' and why it's a poor descriptor: "When suits, politicians, Wal -Mart and mid-level providers see the phrase primary care, they think “simple care.” They think of patients with one problem, like hypertension or even diabetes. They think of urinary tract infections, sore throats and upper respiratory infections. They think of ear aches and knee pain." See folks, us lowly "mid-levels" are grouped together with suits, politicians and Wal -Mart executives - quite the grouping! Second, Dr. Bob seems to think that we are incapable of treating anything that's not simple. Apparently, we focus on one thing only. We don't perform screenings, immunizations, mental health evaluations, make appropriate referrals, etc. Please. Why are you so sour Dr. Bob? Maybe you haven't had the opportunity to work with Nurse Practitioners and/or Physician Assi...