Let nurse practitioners provide prima...

Let nurse practitioners provide primary care

There are 7 comments on the Baltimore Sun story from Dec 12, 2008, titled Let nurse practitioners provide primary care. In it, Baltimore Sun reports that:

As president of the Nurse Practitioner Association of Maryland and a resident of Howard County, I totally agree with Dr.

Join the discussion below, or Read more at Baltimore Sun.

old grunt

Baltimore, MD

#1 Dec 12, 2008
As a physician, a consumer of healthcare and one who has taught and mentored NP students and practitioners, I will stipulate to the fact that they provide good care for routine stable conditions and acute, minor illnesses. Most of them have had several years as nurses before they return for a 2 year course. They then have, as I understand it, no requirement for post-graduate training similar to the minimum 3-year residency training required of physicians. FYI, it takes a minimum of 11 years to train a physician from HS level, it takes 6 to train a NP from HS. They lack practical experience of treating patients gained in a residency program and their training is less rigorous in understanding the disease processes and drug management of diseases.
Currently, the safety net is that each NP must have a collaborative agreement with a physician who is responsible to review their work.
The bottom line is that NPs have loess training and less experience. If you have a choice, would you choose the less experienced practitioner or the more experienced one with more training in treating disease?
Richard K

Crofton, MD

#2 Dec 12, 2008
If you had the choice would you take the appointment with the NP tomorrow vs. wait until 2 weeks to see the MD?

Step away from the bias and jealousy Old Grunt. You know darn well what NPs can and cannot do and I overwelmingly support them, especially if they have a great relationship with the primary MD in the same office. The NPs I have visited can and do provide me with nearly all of the same treatments I can get from my MD but without the wait. And if the NP is not sure about something it's as simple as a knock on the MDs door for a quick consult.

NPs rock in the medical office world!
PCP

Orestes, IN

#3 Dec 12, 2008
Geez, I wonder why go through all the bother of 11 yrs or more of training when NPs provide "Equal and comparable care".

NPs can and should work in collaboration with Primary care physicians, however that relationship should reflect the differences in their stature, training, knowledge and skill, pay differential etc. Right now it is a free for all. I have never seen the NP movement accede to those differences. For them it has always been the "equal and comparable" doctrine. That has been the greatest impediment to better collaboration between the professions to create a system that undoubtedly needs both.
Sandra Nettina

Ellicott City, MD

#4 Dec 14, 2008
I'm glad to see the controversy and comments coming out about the primary care shortage. There is no room for turf battles. We can only serve the patients by using all types of providers and work together for improved health outcomes. A nurse's training and work experience focusing on physical and psychosocial assesment, communicaiton, problem solving, and intervention coupled with the masters level or higher preparation in diagnosis and prescribing prepares nurse practitioners to meet over 90% of patients' needs. Because of the nursing model of education and experience, NPs know when to refer, collaborate, change the plan of care, or simply stay the course with frequent monitoring and follow up.
Zorro

Finksburg, MD

#5 Dec 14, 2008
old grunt wrote:
As a physician, a consumer of healthcare and one who has taught and mentored NP students and practitioners, I will stipulate to the fact that they provide good care for routine stable conditions and acute, minor illnesses. Most of them have had several years as nurses before they return for a 2 year course. They then have, as I understand it, no requirement for post-graduate training similar to the minimum 3-year residency training required of physicians. FYI, it takes a minimum of 11 years to train a physician from HS level, it takes 6 to train a NP from HS. They lack practical experience of treating patients gained in a residency program and their training is less rigorous in understanding the disease processes and drug management of diseases.
Currently, the safety net is that each NP must have a collaborative agreement with a physician who is responsible to review their work.
The bottom line is that NPs have loess training and less experience. If you have a choice, would you choose the less experienced practitioner or the more experienced one with more training in treating disease?
You are correct and because you are correct we need more doctors especially General Practitioners, Ob-Gyns, and Radiologists.

In Europe, General Practitioners are the highest paid physicians--not among the lowest like here. It is going to take a change in national health policy to achieve this goal.

In order to reach the goal of having more critical need doctors we are going to have to make medical school more affordable and give incentives to those who are willing to become GPs, Ob-gyns, etc. Otherwise, we will be compromising the quality of our care and health.
Zorro

Finksburg, MD

#6 Dec 14, 2008
Richard K wrote:
If you had the choice would you take the appointment with the NP tomorrow vs. wait until 2 weeks to see the MD?
Step away from the bias and jealousy Old Grunt. You know darn well what NPs can and cannot do and I overwelmingly support them, especially if they have a great relationship with the primary MD in the same office. The NPs I have visited can and do provide me with nearly all of the same treatments I can get from my MD but without the wait. And if the NP is not sure about something it's as simple as a knock on the MDs door for a quick consult.
NPs rock in the medical office world!
No, we need more GPs, Ob-Gyns, Radiologists, and others. We need to graduate more of those doctors from medical schools. So, we need to give incentives to students willing to go into those areas and make medical school more affordable to alleviate the shortage of doctors.
Diana Heffner

Ellicott City, MD

#7 Dec 14, 2008
90% of outpatient care is routine. It doesn't matter how many years of education you have. The poor health of our country is due to diseases of lifestyle. Good outcomes by NPs are because we know when to refer. Just as MD's know when to refer to a specialist, NP's know when to refer to an MD. More primary care providers of all types are needed with higher reimbursements so that we can spend the time needed to listen to the patient's concerns, to get to know the patient, discuss the treatment plan with the patient and coordinate the care. Poor health outcomes are not because NP's do not have 11 years of education. Poor health outcomes are because of the rushed way we give care with poor coordination. We need to stop these turf battles, learn to respect each other's strengths and concentrate on the real problems.

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