I have worked with nurse practitioners (NPs) ever since I graduated from medical school: during residency, when I did an additional fellowship, and at both my previous and current practices. These experiences have included caring for very premature infants, treating children with cancer, managing the reproductive health of adolescents, as well as primary-care pediatrics. On a few occasions I’ve had to transfer an ill child to another facility, and sometimes the medical provider who arrived with the ambulance to assume care was an NP. I was always grateful when they got there.
With an exception or two, these NPs have been wonderful to work with. (Show me a profession that doesn’t have a few sub-par members. Lord knows I can list plenty of clunker physicians.) I have the utmost respect for them as colleagues, and value the work they do immensely. When I have a patient with a weird rash I want someone else to look at, or when I feel like running a treatment plan I’ve put in place by another person, I am as apt to grab one of the NPs in my office as a physician.
It has been projected that tens of thousands of additional primary-care physicianswill be needed to meet the nation’s health-care demands within a little more than a decade. While increasing the number of residency slots has been proposed as one solution to this problem, allowing NPs to practice with minimal restriction is another possible option. Though many states permit NPs to practice without physician supervision, the majority—including the state where I practice—put some kind of restriction on the care NPs can deliver autonomously.
I am wholeheartedly supportive of allowing NPs to practice without physician supervision. However, not all doctors share my perspective.
In a recent New York Times op-ed, Dr. Sandeep Jauhar lamented New York becoming the latest state to give NPs freedom to practice without oversight from doctors. He cited a study from 1999 that found NPs ordered more tests and consultations than their physician colleagues, and posited that this discrepancy is due to their inferior training and resultant lack of clinical confidence or acumen. He went on to speculate about a two-tiered system in which under-trained and unsupervised NPs would deliver care that is not as good as that delivered by doctors.
I do not believe such a two-tiered system will come to pass. As was mentioned subsequently in a letter to the editor dissenting from Dr. Jauhar’s views, a 2010 report by the Institute of Medicine found clinical outcomes for patients treated by NPs were comparable to those for patients treated by doctors. That finding is entirely in keeping with my own observations of NPs delivering excellent care over the years, both as co-workers and as health-care providers for various members of my family—kids included.
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