Saturday, July 31, 2010

Nurse Practitioner Says "I'm No Physician Extender!"

 This is who I think of when I hear the term "extends".

I was over at Kim's place at Emergiblog and she has a great post about Physician extenders. I, of course, put my two cents in on the subject.

It still amazes me just how little people understand about how we take care of patients. The term Physician Extender gives people the impression that I am hanging onto my collaborating MD's elbow waiting for him to approve my every decision regarding my patients. Most of the time, he has no input at all. If I need some advice, I will ask him to review a chart or come into a patient's room with me and we discuss the case like two intelligent individuals. In fact, he sometimes (imagine that!) even comes to find me for advice as well.

I don't understand why doctors and nurse practitioners and physician's assistants can't all just work toward the same goals for patients. Yes, I know that there is an educational difference. Yes, I know that I didn't attend medical school for as long as you did. Yes, I know that some of the old schools docs still think that I am pretending to be a doctor and that if I wanted to treat patients in the same capacity that I should go to school to "be a real doctor".

Enough already! Get over the fact that we are already doing pretty much the same care with the same quality outcomes. No, I don't want the same money for the job. I don't have the exact same education, so I don't deserve the exact same pay. Oh my gosh! Did I just say that?

All I want is to be recognized as the primary medical care provider that I am. I am a great listener and I am continually learning and adapting to my surroundings in the field. I love my job and would like to be allowed to practice to the maximum capacity of my abilities for one ultimate goal...

Great patient care. 'Nuff said.


  1. It is so sad that other health care professional forget to respect one another even if we all have the same goal. Can they still imagine a hospital without us or should we show them??

  2. This is Victoria, Editor for which is an informational site for different infections and infectious diseases. We have emailed you because we have interest in collaborating with you and your blog to help us spread the information. I look forward to an email regarding the matter, Thanks!

  3. Amen to that sister, is all I have to say!

  4. Texas Nursing Schools, I think that some of the hospitals have seen that first hand with nursing strikes. It's not a pretty sight. We should all work as a team.

  5. Anonymous5:03 AM

    "Yes, I know that I didn't attend medical school for as long as you did" You didn't attend MEDICAL SCHOOL. You passed some dumbed down online classes. If you want docs to respect you go take the USMLE.

  6. Anonymous, My online Master's level medical classes covered much the same as a medical doctor's classes. I didn't go to a medical doctor's college, I went to a Nurse Practitioner program and it was not all online. I have no interest in going to a doctor's medical school at this point in my life. I am in my early 40's and enjoy taking care of my patients in collaboration with my doctor partner.

  7. Anonymous9:07 PM

    Do you really believe a NP's education is "much the same" as a physician's? If you do, go take the USMLE and prove it. Fact is, its nowhere near what a medical education provides. There is no such this as a doctor's medical school and a nurses medical school. There are people smart enough and motivated enough to be physicians and there are people who are not.

  8. I would take the USMLE if they would allow it Anonymous. A doctor that I work collaboratively with has over 40 years experience as a physician and he suggested that I challenge the test if it was allowed. I learned a lot of things that medical docs did and I wish that they could learn what we know too. It's a combined effort out here for the good of our patients.

  9. Anonymous12:46 AM

    Im an NP and took the USMLE practice tests... and did very well. No they do not let us take those tests.. and why should they make us? Since when does another profession tell another a separate profession what to do? But... In all fairness... i believe equal pay for equal work. But, I will settle for salaries that are 85% of what a physician makes in the same area of primary care. Is that happening no. So heres the deal. You want me to take USMLE tests... then I expect the exact same pay as a physician.

    Bottom line.I have a clinical doctorate like a physician. The only think that separates our education is the Residency programs you have to do. We spend the same amount of time in school. Our education is more efficient spreading our nursing / medical training over 8 years of higher education. Physicians medical education is squashed into 4 years. Of course is harder... Physicians are upset because Nursing found a more efficient way to get to the goal. Times change... and there is no evidence out there that suggests patient outcomes are lower when a NP is in charge of their care. Just look at the New England Journal of Medicine and JAMA journals...

  10. Anonymous9:56 AM

    " The only think that separates our education is the Residency programs you have to do". Please correct me if I am wrong but I believe that there is a difference in the educational curriculum between medical school and NP school. The preclinical curriculum of medical school consists of year long courses in behavioral science, gross anatomy, gross anatomy lab, medical biochemistry, medical genetics, medical immunology, medical neuroscience, neuroanatomy, medical nutrition, medical physiology, microanatomy, microanatomy lab, physician and patient, principles of biomedical research, bioethics, business of healthcare, community and preventative medicine, intro to ambulatory care, pathophysiology, medical microbiology, medical microbiology lab, medical pharmacology, pathology and laboratory medicine, and psychopathology. This is all of course followed by the Step I to measure for competency in these courses at which point the student is permitted to move onto 3rd year which consists of rotations in each discipline and ACGME written shelf exams following each rotation, followed by the Step II written and Step II Clinical Skills exam at which point if the student passes will then move onto 4th year of additional sub-I's followed by an internship year followed by the Step III (the real one) followed by 3-7 year residency (board certification exams throughout), followed by for most chief residency + fellowship of 2-3 years followed by state and board licensing exams. Are NP schools really mirroring this exact education sans residency?

  11. Do you really use all of the organic chemistry, physics, calculus etc to treat patients? Not unless you are a pharmacist or a researcher. In the real trenches, it takes a diagnostician and someone who listens to patients and actually cares about them. NPs have a all of your components in their training if they go to a good program. I think the university system is making is harder for people to complete their MDs than it needs to be and I think it's all about the money to feed their system. My education did not stop when I finished school. I research and learn things on a daily basis. I have an awesome collaboration with the MDs in our company and NPs and PAs are treated on equal footing without any feeling like we are not as good a provider. I have been told by a well respected MD that he thinks that NPs should be able to take the MD boards by challenge because he thinks I could pass them. I took that as a very nice compliment. It's not about the them vs us in the real world. All we want is to take care of our panel of patients and go home to our family for some down time and make a few bucks along the way.

  12. RN to NP to DO10:04 PM

    Organic Chemistry, physics, and calculus are not included in the curriculum of any medical school, rather they are a few of the required courses which pre-medical students are required to take at the undergraduate level. The traditional pre-med track, along with the MCAT, are used as relatively accurate indicators of intelligence/high academic aptitude to identify those students capable of handling a medical school course load and weed out those who do not belong. With that said, understanding Organic Chemistry is critical for having an adequate understanding of many of the major concepts in Biochemistry, which is the foundation of understanding of thousands of clinical disease processes. If you would like to take a crack at the MD boards you can start with a brief practice assessment for the first step of physician licensing exam series here-->

  13. RN to NP to DO10:04 PM

    "I have a unique perspective on this. I am a physician (i.e. I actually went to medical school). I was also a nurse and took NP classes.
    There is absolutely NO comparison between the two. ZERO. Most NP programs contain less actual "medical" classes than you get in one semester of real medical school. Mine was 15 credit hours. The rest is nursing theory, research, nurse political activism and such. It is so unbelievably different, you can't compare the two. The truly scary thing is that they don't how much they don't know.
    NPs, DNPs have absolutely NO right to independent practice. I think there is a role for them such as running coumadin clinics, helping with post-op evals, vaccinations and other such limited practice.
    They simply do not have a fraction of the knowledge that the worst FM physician has. Not even close.
    Imagine this. Would you let a fourth year medical student open up a clinic and do primary care? Heck no! And the fourth year medical student already has VAST more medical education than an NP or DNP.
    If this does not bother you, it should."

  14. RN to NP to DO10:04 PM

    "I would like to offer a bit of perspective as well on this debate. I became a nurse in 1998 via an Associate Degree program, taking and passing with flying colors the same NCLEX that BSNs must take to become RNs. I knew then that I did not want to finish my education, as I wanted more knowledge than nursing school offered. I continued into my BSN/MSN education right after graduation, finding a ton of bias against LPNs/ ADNs and diploma nurses from yesteryear in the 4 year programs, who wanted all nurses to be required to have at least a BSN to 'manage' patient care. The lesser degrees they felt were good enough to do grunt work. I was offended to say the least, as I was able to run circles around my counterparts from 4 year schools right out of the gates.
    I ended up in the BSN/MSN program, because I was not sure where I wanted to go with my education, and it made sense to at least increase my standing in my current career. As I took the classes that were required to complete my BSN, I was more often offended than educated, inundated with left wing, liberal union propaganda given in the guise of nursing process text books, and my Nursing Theory book was basically a 30 lb book trying to discredit LPNs and ADNs. I was angry for all the years it took for me to complete that degree. I was completely disenchanted with nursing classes, and even though I had dual credit (for my BSN and for the NP program) I was having a hard time deciding whether or not to proceed in the NP program. Fortunately, after speaking with many of my doctor friends and family, I decided to go for it, even though it meant instead of 2 more years (for my NP) I would be in school 8-10 more years (because of the prereqs that I didn't need for NP school, like Genetics, Biochem, Organic Chem, Physics) plus the actual med school and residency.
    I am so glad I went the route I have, as a 3rd year med student. Many of the people in my class who found I was a nurse thought I would have all kinds of advantages in the classroom, but not so much. Nursing does not focus on the science of the human body. After the first two years of medical school I have learned so much as to the Why of what I did in my TEN YEARS as a nurse, that I was actually upset. If nurses knew half of the Why for what we did on a daily basis, patient care would be SOOOO much better, but then doctors would be giving daily care for each patient.
    Clinically, I may have a slight advantage, because of ten years of hands on experience, which cannot be taught in a classroom. I know many young nurses from when I trained them, that never put in actual hands-on, post-grad work, just graduated from their BSN and entered directly into a Masters program in Nursing for NP, Hospital Admin, or Community Health. I have always found it hard to swallow that those that have actually never had to work in the trenches getting their hands dirty are able to become the ones that are to dictate how that care is to be given.
    So, I am thrilled to be able to get a Medical Education, and know that the two processes are vastly different. I have learned so much in the last two years, I can hardly believe it.
    I would not say ever that NPs do not have a huge place in primary care, as there are a lot of mundane issues that do take up a Primary Care Doctor's time. Sore throats, allergies, med refills, physicals, well exams, etc. are easily something managed by a well prepared NP. We MUST have doctors there for when the mundane rapidly changes into a rare disease, or a critical incident. Please, anyone who reads this know that education and training are not the same".

  15. Anonymous6:29 PM

    A few years ago there was a pilot program to let nurses take the USMLE Step 3, the same exam doctors have to take. It was at the Columbia DNP program in New York which is the "best" DNP program in the country.

    Guess how many of them passed it? Only 10%. Doctors pass that test at a 99% rate.

    Dont sit there and lie about how you could pass the same tests, because it is all a lie.

  16. Anonymous7:42 PM

    This is really getting out of hand. We need to put strict regulations on the NPs so that they can take a pay cut. They are already being paid too much to do the work inferior to a physician. We need to make sure that they do not continue to lobby congress and change health care forever. Congress can not compromise on this! NPs are for humanizing medicine and each day they make patient's lives better, however, we need to make sure their wages do not go up and we need to make sure their privileges are not expanded.

  17. Anonymous7:43 PM

    Sure you took the USLME...This is the prob

  18. Frustrated College Student7:51 PM

    I'm tired of this politics. Quit pretending you learned more than us. Here's an idea. Currently I volunteer at a local hospital. I'm a senior who's taking many relevant courses in general biology,human physio, biochemistry,genetics, histology, neurology, and even some practical ones like urinalysis&hematology. I've also taken a couple of undergraduate courses in bioethics and I know everything nurses know about healthcare and even more about human biology. Why am I a volunteer? Either make it so that nurses also work on a voluntary basis or make it so I receive their salary! I demand equality!

  19. Anonymous10:48 PM

    If you wanted to be a primary care provider, you should have gone to med school. We have a division of labor. You can't be a singer who has a working knowledge of the piano and chose to play keys in the band when you have a keyboardist at the table.