The more medical news and opinion I read, the more I hear about the so called “war” between physicians and nurse practitioners. Before I began blogging, I hadn’t heard of or felt at war. I didn’t feel the need to don fatigues, strap on my boots and prepare for battle with my physician coworkers during my morning commute. So, maybe this fight is a new one or perhaps I was simply ignorant of it’s existence.
While most practicing nurse practitioners don’t sense contention with their physician coworkers on a daily basis, there is somewhat of a war between MD’s and NP’s on organizational and political fronts. Physician groups are trying to protect their sovereignty over medicine, maintaining their position as the sole or at least ultimate medical authority. Meanwhile, nurse practitioner organizations are lobbying for more independence. They are persuading lawmakers to increase NP’s scope of practice. In the current political climate of health care reform and the cry for cost effective medicine, nurse practitioners are gaining ground.
In reality, most nurse practitioners work under some level of physician supervision. Even if supervision or collaboration is not mandated by state law, physician run practices and hospitals are the largest employers of NP’s. Most nurse practitioners simply don’t open their own clinics. This isn’t a bad thing. Physicians are more extensively trained than nurse practitioners, it’s a simple fact. As an NP, I would not have been qualified to practice alone right out of school. Even though most nurse practitioners work side by side with physicians or at least with a physician readily available for consultation, some NP’s ultimately decide to open their own clinics and practice independently.
NP’s practicing independently are at the crux of the war between NP’s and MD’s. These entrepreneurial nurse practitioners are the ones who pose the greatest threat to physician groups. So, how do we as NP’s and MD’s come to an agreement over the issue of independent practice? Physician blogger Kevin Pho posed an excellent proposition last week on his blog, KevinMD.
Dr. Pho proposes a unified primary care certification. He believes MD’s and NP’s who want to practice independently should take the same qualifying exam. Everyone desiring to lead a primary care practice should take the same test. This is an excellent proposition.
Not all nurse practitioners are qualified to practice on their own. NP’s simply have a more limited level of education than physicians. This doesn’t mean we can’t practice for a few years gaining the knowledge and experience qualifying us to go it alone. But, some of us aren’t ready to practice independently. Dr. Pho uses the Doctor of Osteopathy to support his argument. He notes that osteopathy was originally viewed with suspicion by physician organizations. However, osteopathy graduates pass the same medical board exam as MD’s before being eligible to practice. This has allowed them to be viewed as equivalent to MD’s in the eyes of the public and most physicians.
By creating a unified exam for primary care independent practice, NP’s would gain legitimacy in the eyes of the public and physician groups. This exam would serve as a method of quality control ensuring that only NP’s with adequate knowledge step out on their own. No, I don’t think all NP’s should be required to take a unified exam, just those who want to practice independently. This seems the perfect solution to ending the NP-MD war.