An article in my local newspaper on March 10th, More Training, Bigger Roles for N.C. Nurse Practitioners, got me so fired up that I dashed off a response before the day was over.

I knew as I composed my letter-to-the-editor chiding the North Carolina Medical Society for ignoring research that proves nurse practitioners’ practice is safe and effective I was avoiding the word “competition.”

Competition is a word I have avoided for many years. Maybe because I still have memories of a time in the mid 80’s when we NP’s in Illinois were lobbying for prescriptive authority.

rn caduceusBecause we didn’t want organized medicine to block our attempts, we stressed NP-MD collaboration. The truth was that patients might prefer to see an NP since we charged less for a visit, spent more time with each patient and in some instances delivered better care, especially when the patient had a chronic ailment. We knew if we could prescribe medications without asking a doctor to write out a script for us we would certainly be competitive.

During that time, CBS visited the clinic I worked in to investigate our relatively new nursing model, nurse managed md-caduceus-medical-doctor-vinyl-decal-stickerhealth center, where advanced nurses (nurse practitioners and nurse midwives) saw patients. Doctors were hired to support the nurses.

Susan Spencer, a medical reporter, put everyone at ease in spite of the cables, cameras, and lights scattered throughout the clinic. Microphones were shoved under the chins of staff and patients alike. When it was my turn, I perched on a stool in the narrow lab off the main hallway. The doors were closed and the heat from camera lights added to the claustrophobic atmosphere. Susan Spencer asked questions about nurse practitioners in general, and about our practice in particular.

In spite of my nervousness, I was giddy from all this attention, anxious to please. Whatever Susan wanted to hear, I would oblige. Then she TV cameraasked, “Why do physicians object to nurse practitioners practicing independently?” I immediately answered, “We are competition.” I remember the feeling I had when the word “competition” flew out of my month. On national news yet.

The program aired a couple of months later on The Evening News with Dan Rather for all of two minutes. The president of the American Medical Association had also been interviewed saying the usual: “If NP’s want to treat patients let them go to medical school to be doctors.”  And then my face appeared and I uttered that fateful word.

I had my few minutes of fame. Nothing horrible had happened. The only person who saw the show besides an old patient of mine and my cousin who lived in Florida was a window repairman. The day after the program appeared on TV he lugged his ladder and buckets in though the front door of the health center to work and said, “When I found out what you nurses do, I dropped all my other work and came to get your job done.”

Otherwise life went on as usual. I never used the word competition in the same breath with physician practice again—until now.

Competition is not a bad word. In the business world it can control costs and improve services. So let’s encourage competition in the health care industry in order to make every citizen in our country as healthy as possible.

There is more than enough need to go around.

By Marianna Crane

After a long career in nursing--I was one of the first certified gerontological nurse practitioners--I am now a writer. My writings center around patients I have had over the years that continue to haunt my memory unless I record their stories. In addition, I write about growing older, confronting ageism, creativity and food. My memoir, "Stories from the Tenth Floor Clinic: A Nurse Practitioner Remembers" is available where ever books are sold.


  1. Thanks for this informed post, Marianna. And I hope the doctors will let the nurse practitioners do their work, unimpeded. The needs for medical care are so huge. It would be a shame for the fallout from competition to get in the way of folks receiving the medical attention they deserve.


  2. The medical organization tries to restrict other professionals, too, such as nurse midwives, chiropractors and practitioners of alternative medicine. This self-serving behavior would be better directed at encouraging a variety of health care services to meet our national health care needs, especially in underserved areas.


  3. I remember this experience of yours. It’s so disheartening to see the competetion issue still present. Why can’t we all work together, recognizing what we each have to offer and not undermine, or overestimate, the education and skills of others? Really, put the patient first. What a novel idea!


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