How Do Physicians View Nurse Practitioners?

Reports of how physicians feel toward nurse practitioners are conflicting.  On one hand, nurse practitioners save physicians time and money in their practices.  On the other hand, there is concern of a ‘turf war’ between NP’s and physicians as legislation increasingly allows nurse practitioners to open their own practices across the country.  Ultimately, how do physicians view the nurse practitioner profession?

Healthcare reform, the projected shortage of primary care physicians and the threat of decreased reimbursement from Medicare has reinvigorated the debate over the role of nurse practitioners in the healthcare field.  Some physicians are worried that nurse practitioners provide a lower quality of care than that of physicians.  Others express concern for the physician job market as nurse practitioners are opening their own practices in increasingly large numbers taking a cut of the patient population.  There are two views we must examen in evaluating the relationship between physicians and nurse practitioners; we must look at the official statements made by physician organizations as well as the actual experiences of nurse practitioners working side-by-side with physicians.

How Do Physician Organizations View Nurse Practitioners?

Overall, physicians organizations officially see nurse practitioners as an asset to medical practice but only when working in conjunction with a physician.  Physician organizations do not support the independent practice of nurse practitioners.  The American College of Physicians, for example, states “patients with complex problems, multiple diagnoses, or difficult management challenges will typically be best served by physicians working with a team of healthcare professionals that may include nurse practitioners”.  The American Academy of Family Physicians states “the nurse practitioner should not function as an independent healthcare provider…the nurse practitioner should only function in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician”.  Physician organizations typically point to a lower level of education and skill among nurse practitioners as the reason NP’s should not practice independently.

What Do Individual NP Experiences Indicate About the Relationship Between Physicians and Nurse Practitioners?

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The negative views of physician organizations do not seem to permeate into physician practices that employ nurse practitioners.  Although physician organizations take a stance against nurse practitioners, in my experience, most nurse practitioners feel valued as an asset to their practice.  Physicians I have worked with seem to truly approach our professional relationship with a collaborative attitude.  In patients with whom I am competent to treat, they do not get involved or question my decision making.  They trust my level of expertise and allow me to make my own decisions.  When I do have questions or ask for help or advice in treating a patient with complex medical problems they are available to help.  I have found this to be true among my other NP friends, especially those working in specialty practices where complex medical situations frequently arise.

When I worked in the primary care setting, I found that I practiced almost completely independently.  In fact, the physician who owned the practice was almost never present.  He was available by phone for consultation but I rarely needed assistance.  He respected my ability to practice competently.  I was a valuable asset to him as he did not have to see nearly as many patients and could focus more on the business aspects of managing the clinic.

Nurse practitioners working for physician groups are not technically practicing independently and are therefore not subject to the scrutiny and negative views physician organizations have toward those in independent practice.  Does this mean you should avoid independent practice as a nurse practitioner?  No!  If you work independently you will not be interacting with physicians anyway!  My view is that NP’s are perfectly capable of independent practice.  Might you need to refer a complex patient to a physician or specialist?  Of course!  Physicians do this too.  Physician organizations need to realize the abilities of nurse practitioners and the quality of care we provide our patients as many individual physicians already have rather than viewing NP’s as a threat to the medical field.

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