“That Doctor Is A Nurse!”

Little Steven Pascal laughed out loud and pointed at my wife the first time he saw her. Initially, I didn’t understand why. She looked very respectable in her crisply ironed white lab coat, pink silk blouse, three-quarter length skirt and conservative black pumps; I thought she looked lovely.

“Look, Mommy”, he blurted out, “that doctor is a nurse”, to which his mother mumbled back something about both boys and girls becoming doctors.

Steven was more right than his mother, though; my wife isn’t a doctor, but a Nurse Practitioner. She no longer works in a medical office setting, but for ten years we worked side by side and she still enriches my professional life with her insights and advice.

I helped train my wife, who became a better clinician than I am. I also helped train one Nurse Practitioner who became Director of a Nurse Practitioner program at a nearby university and another NP who started her own practice for psychiatric patients with medical problems.

It is time I write about Nurse Practitioners. The subject came up briefly in my post “Time, Money and Midlevels”, which was also republished by KevinMD.

Nurse Practitioners have a Masters degree in Nursing, which generally is a six-year university education, and several years of clinical nursing experience.

Early on, Family Nurse Practitioners were a welcome addition to the primary care workforce in underserved communities when the new Medicare and Medicaid programs increased the number of eligible patients.

Over the years, Nurse Practitioners have found work in many other specialties, from dermatology to orthopedics, emergency medicine and inpatient care. Often, Family Nurse Practitioners were hired by specialist physicians and received on-the job specialty training. Even in states where NP’s can practice independently, Family Nurse Practitioners often choose to work as “physician extenders” in specialty areas under continued supervision by specialist physicians, who assume responsibility for the Nurse Practitioner’s work. This is basically how Physician Assistants work. In recent years there has been a backlash from the Nurse Practitioner credentialing bodies against this. They have insisted that NP’s stay within their scope of practice, based on their initial training, and not change specialties after graduation by working under the supervision of a physician in a different specialty.

The credentialing bodies for Nurse Practitioners offer Board Certification in nine different specialties. A Nurse Practitioner who wants to switch specialty would have to go back to school in order to qualify for board certification. While this strengthens the professional standing of Nurse Practitioners, it also limits their ability to take advantage of mentoring opportunities, change with the times and follow new trends in the job market. It may put seasoned NP’s at a disadvantage versus newly trained ones by not allowing them to be “grandfathered” into specialties they are already working within.

It has been said that physicians protect each other’s interests and tend to go easy on each other in licensing and credentialing matters. Many people I talk to say the opposite is true for nurses.

NP’s bring a nursing perspective to the practice of medicine. Patients who prefer a medical provider with a collaborative style, a focus on education and an interest in patient-centered medicine often seek them out. Not that all physicians are authoritarian, but that is a perception many patients have of us.

The quality of care delivered by NP’s in primary care has compared favorably to that of physicians. Critics say that is because NP’s tend to refer out their sickest patients. That is certainly true at every level of health care; there are always bigger clinics and more subspecialized specialists any one of us can refer our patients to. All clinicians need to do what Nurse Practitioners talk about – stay within their scope of practice.

Having worked with many Nurse Practitioners as well as osteopathic and allopathic physicians from dozens of countries, my belief is that education is only the minimum requirement to enter the healing professions. We are challenged to deliver our best in every patient encounter. The initials after our names don’t make our patients or their diseases more or less important. We are all healers.

A subspecialist at Cityside hospital once told one of my wife’s patients that she was in good hands with her choice of primary care provider:

“I trust her more than most of the doctors around here”.

That’s my wife, a Nurse Practitioner.

6 Responses to ““That Doctor Is A Nurse!””

  1. 1 Omri July 20, 2010 at 12:16 am

    As an up and coming 1st year med student, I would be interested in hearing what you have to say about doing the MD/DO route as opposed to the NP route. If one can have the experience and training required to heal another person as an NP, why bother being a physician who has all of the debt and bureaucracy to deal with.

    • 2 FNP Student July 20, 2010 at 11:12 am

      You could if you wanted to. It only requires that you get through nursing school with a Bachelor’s degree, near the top of your class, pass your board exams, get years of nursing experience (most NPs have been nurses quite a while before going to NP school), and then getting a spot in an NP program which is very competitive, finish NP school (a MSN or DNP degree) pass a certification exam, and Bingo! you have it.

      Good luck in medical school. I hope you choose primary care, we need as many primary care physicians as we can get!

    • 3 Scott Hamilton, MD January 1, 2017 at 11:55 am

      As a PHYSICIAN, I agree with you wholeheartedly. The NP is a legitimate practitioner but only within a narrower, well-defined scope of duties with close supervision of a fully-trained physician. My experience is that this “supervision” occurs for about two weeks and is then discontinued due to the physician’s lack of time, false comfort, and laziness. To allow these mid levels to practice as physicians–as they do in offices as well as hospitals where they are seeing the sickest of the sick–would imply a “consensus” that they are interchangeable with the fully-trained and long-experienced physician who–according to certain “governing bodies”–also requires periodic, expensive, and time-consuming recredentialing. Make up your mind, people. What amount of training and “retraining” is actually necessary? I see us sliding halfway down a very slippery slope, folks. But few seem to notice, and even fewer care.

  2. 4 FNP Student July 20, 2010 at 11:06 am

    Thanks for your post. I am a student family nurse practitioner and about to go into the clinical portion of the program. I have been a nurse for almost twenty years and wanted to be able to do more for my patients. My goal is to practice in a rural area as I grew up in a farming community and love the country.

    I have had a blog for a while and get both positive and negative comments from medical people, and it saddens me to think that there are still MDs who feel threatened by NPs. To me, it is about the patients. Both MDs and NPs want to provide the best care and each discipline has their own strengths and weaknesses. Together, we all make a great team.

    I currently live in Florida, and the state medical association here uses members in our state legislature to stymie any bills that would help NPs practice. Too bad for Florida.

    Thanks again for your post. I continue to enjoy your blog.

  3. 5 Wanda Dabrowska March 16, 2018 at 2:33 am

    I do agree totally with you on value of nurse practitioners in medical setting but with close supervision and collaboration of physician, in supporting role..
    My convicion is based on nearly forty years of clinical work as a physician in three different countries. I had to get recertification twice , regardless of recognized qualifications.
    I had plentiful experiences with variety of supportive services including ‘nurses specislists.’
    My experience tought me to trust only those pracitioners who I trained myself and continiued doing so over the period of our collaboration.

    History of past centuries led us to establishment of Medical Schools , to development of teaching programs now encompasing bases for understanding of rapidly expanding knowledge for its future utilization.
    Assessment of a patient today is not easier then it used to be .We have to be able to deal with more complex issues than we did in the past. Therefore I do not think that establishing independent clinics for Nurse Practitioners imay provide us with standard of care which is expected in twenty first century.
    I see however an important role for Nurse Practitioners as a part of a team with a well defined collaborative role.

    • 6 Phyllis Boone ANP-BC December 29, 2020 at 8:33 pm

      I respectfully disagree with you, Dr. Dabrowska. In 40 years, you only needed to recertify twice in your 40 years of clinical work? Evidently you are not aware the the MSN- NP and DNP are required to undergo re-certification every 5 years. Maintaining certification requires practice in one’s field of certification, rigorous continuing education requirements in pharmacology and complex practice issues along with teaching and mentoring work. Like you, I have a tremendous responsibility to provide knowledgeable, skilled professional care for those who trust me with their medical needs. That professional commitment may well involve consulting other professionals such as yourself. I would hope that those professionals would attend to their certifications more than once every 15-20 years.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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