Practice Notes

'Nurses are not doctors': Nurses respond

by Anita Joseph

In Dr. Sandeep Jauhar's controversial New York Times op-ed, "Nurses Are Not Doctors," the cardiologist wrote that proposals to expand nurse practitioner (NP) autonomy are misguided because they "underestimate the clinical importance of physicians’ expertise and overestimate the cost-effectiveness of nurse practitioners.”

Jauhar noted that NPs receive approximately one-third of the clinical instruction that physicians do. He cites a 1999 study indicating that patients treated by NPs rather than physicians require more imaging and specialty consultations to be diagnosed and have higher rates of hospital admissions.

In a particularly vocal comments section, reactions to the piece from across the country unified around several points.

NPs do provide high-quality, cost-effective care

Kate Mitchell, an advanced practice nursing (APN) student at the University of California-San Francisco, notes that the 1999 study Dr. Jauhar cites does not say that NPs compensate for a lack of training by ordering excessive diagnostic tests, but rather, "the researchers 'found a trend toward increased utilization…but for most of these [measures] our study lacked sufficient power to show statistical significance'."

Mitchell adds that a systematic review of APN practice from 1990 to 2008 concluded that APNs' patient outcomes are comparable with MDs'.

Care from a NP is better than no or delayed care

David Bacon, a veteran from Aspen, Colo., noted that due to a physician shortage in the Army, physician’s assistants often provided independent care. This was better, he said, than waiting weeks to visit a PCP, right up to the point where an AP misses a symptom or sign of serious disease.

A commenter from Chapel Hill, N.C., agreed, saying, "Many doctor-only staffed practices have long waits to see one's regular doctor, even in an emergency. Even with an appointment a patient can wait hours to see a physician. Access to a nurse practitioner can be the difference between getting care and waiting until emergency room services are needed."

Undermining NPs damages the conceptual foundation of team-based care

The safe practice of medicine is dependent on mutual trust beyond providers, that each provider will practice to the top of their license and no more. APs who wrote into the comments section insisted that they are as protective of this trust as are PCPs.

Rein Tideiksaar, a PA from Blackwood, N.J., notes that he is allowed to practice independently because if he sees a complaint beyond his skill level, he quickly refers to a physician—just as PCPs who see a complaint beyond their skill levels refer to a specialist.

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