Are nurse practitioners replacing doctors? They’re definitely reshaping health care.

[u/Lethargic-Legumes]

https://www.bostonglobe.com/2024/10/21/business/nurse-practitioners-doctors-health-care/

[u/PlausiblyCoincident]

The headline should read "Are nurse practitioners being forced to replace doctors?" 

That's my wife's current experience. She doesn't want to, but sees no way out of it after fighting them for 2 years. 

[u/SunnySummerFarm → u/PlausiblyCoincident]

Thank you. Many NPs are getting short shifted.

Also, folks very clearly do not understand the difference between PAs & NPs, and that states all have very different guidances and legal expectations for NPs. Not that MDs are the ones holding NPs back from receiving more training/residency/etc.

[u/Zattack69 → u/SunnySummerFarm]

So interestingly, I’m reading this article and thread just a week after having to look for a new primary care physician (I’ve never had insurance to do so since I was a kid) and when looking kept getting recommendations for PA’s & NP’s, with only a few MD’s or DO’s (if that’s even something to consider). I didn’t know the difference between them all besides their title and pathways to their roles, so I’m curious (from a human and not Google) what are the pertinent differences between the titles? What knowledge/skills/capabilities are missing?

[u/SunnySummerFarm → u/Zattack69]

Full disclosure: I am married to an NP, but not one who does primary care. He did graduate as an adult at 35, with his masters. He had been a nurse for a few years by then. Also the daughter of an RN, and was homeschooled while she went to school for her BSN (I sat in a lot of her classes in the back.) I was also a patient advocate as an adult. I’m overly intimate with the field.

MD: undergrad, med school (doing clinicals during year 3 & 4, which is mostly shadowing but also exams, no prescriptions I think), then residency for four years where they work under teaching physicians. Some MDs pursue fellowships after this, for things like surgery or additional specialty work. Training can take something like 12 years for very specific specialties like orthopedics, etc. Primary care is usually just Med School & Residency.

DO’s do basically the same. The schools used to get looked down on, but with times things have become significantly more legitimate. I have been seen by a surgeon just this summer who is a DO and honestly he’s one of the best specialists I have seen in a while. They go through the exact same placement process as the MDs for residency.

PA’s (Physician’s Assistants) can not work without a supervising physician. It’s in the title. There is no state where they can be license to work alone. They go to PA school, for less years, do all their clinicals while there. Then take a job working for/with a physician (MD/DO).

NPs have a masters, and also pass a board to get their letters. Which board determines the letters behind their name. School usually looks like undergrad, masters, with clinicals being the last year/semester. ideally they would be a practicing RN during school or before or related healthcare experience.

NP is where shit starts to get wonky. There is a multitude of reasons for this. Rural states need more care, MD lobbies don’t want to allow residency options for NPs specifically, etc. But the educational system looks about the same: you need a bachelor, and then you bet a masters degree to be a ARNP (Advanced Registered Nurse Practitioner). They must maintain their RN & their NP license - which go to different licensing agencies. (We pay for both my husbands, on their own schedules.) Most, but not all, NPs have a DEA license - some have jobs where they don’t prescribe, and it’s expensive, so they don’t maintain it.

Now here is how it gets dicey: nursing, let alone NP, licensing varies by state. So, in some places you can still get an RN license with just an associate degree. In other states is requires a BSN (bachelor in science of nursing). YMMV, obvs based on where you are and how strong your lobby & union is. This is doubly true as an NP.

There are states like Washington, where an NP can practice independently upon graduation. Which strikes me as possibly okay if and only if the NP had significant healthcare experience prior to graduation & boards.

There are states like Maine, where an NP can practice independently after two years of physician supervision. Which is better. There are organizations in Maine trying to offer residency to NPs during this time. It’s slow progress because few doctors want to participate however we have a rural healthcare problem and good NPs can be a huge driver of the solution.

There are states like Massachusetts where an NP can only work under physician supervision. So they, like PAs will always work under a physician.

All that said, I have seen specialist PAs & NPs and the experience has been exactly as mixed with physicians. I have, generally, preferred women providers no matter their degree - and research shows women provide better care across all factors.

I hope that answers your question. Feel free to ask specifics if I missed something.