Like Hamburger Helper, but with stethescopes*

Asks Pierre Corneille:

What is your view of the rising use of nurse practitioners?

Hurrah!  An easy question I might be able to answer adequately.

I think they’re great.  (And not just because there are three in my office who might one day discover my blog.)  From residency up until today, I’ve worked with NPs in every setting.  I have had an almost entirely positive experience, and the one NP I worked with who I didn’t particularly respect was in a department where some of the MDs were no great shakes, either.  I’ve seen NPs deliver expert care resuscitating very premature infants, administering chemotherapy, treating mental illness and delivering plain old primary care.

As a physician, I do have more training than the NPs in my office.  Thus, my responsibilities are somewhat greater, and I’m sometimes asked to consult when one of them has a more complicated patient.  But there isn’t one NP in my office now (or at my previous practice) who I wouldn’t trust to take care of my son for most issues.  And if I end up in some emergency department and have to choose between the intern on duty and an experienced NP, I’ll take the latter thanks.

We doctors really, really like to protect our prerogatives.  (This is probably not unique to physicians among professionals, but I can only comment about what I know.)  It’s hard to get into medical school, make it through the institutionalized hazing known as residency and get out into a good practice.  There are pressures and demands that temper the rewards and prestige, and we’ll be damned if we let those rewards and that prestige get eroded or diluted.  I understand these feelings, because I share them to a certain degree.  But I can’t honestly assert that only MDs can provide good patient care, and that we’re always more competent or diligent.

I try to reflect my respect for NPs by referring in most posts to “medical providers” or “healthcare professionals” instead of just “doctors,” because I believe NPs are colleagues and not subordinates.  What’s true for me and my practice often applies to them, as well.  I value the work they do, and if we’re going to provide care to all the people who need (or demand) it, then we need to recognize all the people who contribute to that effort.

* I’ve often seen the medical profession stumble over how to describe NPs.  “Allied health professionals” was one phrase that seemed unwieldy.  I’ve heard another couple, which I can’t recall off the top of my head, that emphasized a subordinate role and that seemed to ruffle feathers.  The term that seems to have gained traction is “physician extenders,” which I find hilarious.  Like you don’t have quite enough physician to go around, so you need to stretch us out a bit.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


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