Tuesday, April 30, 2013

Nurse Practitioners are not Medical Doctors

There is a national bill in the House of Representative called "Truth in Healthcare Marketing Act of 2013," (HR 1427). This would clarify for patients’ who someone is in healthcare.

Even if they have a doctorate or PhD, a nurse practitioner, chiropractor, physician assistant or psychologists is not a medical doctor. If you are treating someone in my family I want to know your background. I am proud to be a nurse practitioner and we have a lot of power as NPs. We perform physical examinations, diagnose and treat illnesses, order and interpret tests, prescribe medications in most states, and plan and implement therapeutic interventions.

On the other hand, I am not foolish enough to put myself in a class with most medical doctors, and patients should not guess who is wearing the white coat. I have met only one NP who was narcissistic and insisted she be called doctor by staff. Beside setting herself up for a lawsuit, I won’t tell you what the staff called her behind her back.  

This is a relevant topic because to be blunt, many patients are not educated enough, and have no clue to know the difference between the people in white coats. I wear a white coat now, but even in my nursing scrubs with my RN badge on, patients regularly call me doctor, and probably only because I am a male. Talk about confused.

Truthfully, anyone with a PhD or doctorate can call themselves a doctor, but that does not make them a medical doctor. In fact there are a lot of people out there in the world with PhDs and doctorates who like to be called doctor, and that is fine. However, I would never have them touch or get close to a real human being.  Thousands of people have Honorary Doctorate degrees like Stephen Colbert or Bill Cosby and can call themselves doctors. Do you really want them, a psychologist like Dr. Phil or the guy at the gas station with a PhD diagnosing your intracranial bleeding or cardiovascular disease?  

Thank God I know some doctors well enough to ask them medical questions, and I do so often. I am not a fool and will not pretend that I have the same education as a medical doctor.
MD's learn the medical model and as medical students they spend 10-15 years in higher education, medical schools and residency, and if they specialize add more years to that.
A nurse practitioner learns the nursing model and may spend 6-8 years in school.

 However, nurse practitioners are better and more equipped to deal with patients in several ways. We were trained to treat people more holistically and not just in a narrow allopathic or western form of medicine. We communicate better with patients and their families. We see the big picture more often. In most hospitals I have worked and research papers I have read, nurse practitioners consistently have a higher overall patient satisfaction score.  

Most docs love us and as NPs and PAs we are part of the solution to the primary care shortage. But a few bad apples can ruin it for a lot of people when it comes to trust and working together.  

Monday, April 22, 2013

Nurse Practitioner Scope of Practice Grades by State

NP's scope of practice varies widely from state to state. I know where I live and many states have current bills trying to improve NP scope of practice. Primarily because of the new Affordable Care Act, the shortage of primary care doctors and an aging population.

The state ranking below are from the Pearson Report. The most interesting thing I found was that only 24 states restrict Doctorate and PhD NP's from calling themselves Doctors. This is a pet peeve of mine, because as an NP you should never imply to a patient that you are a doctor without clarifying you are a NP. (more on that another time)

Hopefully change happens sooner rather than later in more of these states.

2011 Pearson Report
NP scope of practice laws

Alabama:  F                       Alaska:  A                      Arizona:  A                     Arkansas:   D
California:   C                    Colorado:  A-                 Connecticut:  B               Delaware:  C  
Florida:   F                        Georgia: F                       Hawaii:  B                      Idaho:  B
Illinois:   D                         Indiana:  D                       Iowa:  B                        Kansas:  C
Kentucky:  B                     Louisiana:  D                    Maine: A-                     Maryland: A-
Massachusetts: D              Michigan: F                     Minnesota: C                 Mississippi: C
Missouri:  F+                    Montana: A                     Nebraska: D+                 Nevada: C
New Hampshire: A+         New Jersey:  B                New Mexico:  A             New York:  B
North Carolina: F             North Dakota:  A             Ohio:  C                       Oklahoma:  C
Oregon:  A+                     Pennsylvania:  C               Rhode Island:  A          South Carolina:  F
South Dakota:  D              Tennessee:  C                   Texas:  D                         Utah:  B
Vermont:  C                      Virginia:  D                       Washington: A+           West Virginia:  C
Washington DC:   A          Wisconsin:  C                   Wyoming:  A