NURSES DON’T WANT TO BE DOCTORS

For the life of me I don’t know why the New York Times published Sandeep Jauhar’s essay, “Nurses Are Not Doctors,” in the Opinion Pages on April 30, 2014. His essay argued that nurse practitioners shouldn’t practice independently.

As a nurse practitioner it’s obvious that I wouldn’t agree with his opinion but his case was lame. He cited only one study, which was published in 1999. It showed that primary care patients seen by nurse practitioners had 25 percent more specialty visits and 41 percent more hospital admissions than those seen by physicians. Not only was the study dated, it was limited in scope. Come on Sandeep Jauhar. Come on New York Times.

Jauhar further suggested we need more primary care physicians (true) and his solution to encourage graduates to go into primary practice rather than specialize was to increase salaries. Read Shikha Dalmia’s article in Forbes, August 26, 2009: The Evil-Mongering of the American Medical Association, in which she discusses the effects of excessive physician salaries and the historical basis for the physician shortage, which only shows how ludicrous Jauhar’s suggestions were.

Finally, he concluded that nurse practitioners are essential but only “as a part of a physician-led team.”

Angered by the slanted and self-serving article with a title that I had hoped never to view again in my lifetime, and the fact that I thought this essay so beneath the New York Times to print, I wrote a Letter to Editor:

As a retired nurse practitioner, I am disturbed by Sandeep Jauhar’s Op-Ed piece: Nurses Are Not Doctors (April 30). Over the years doctors have criticized nurse practitioners’ practice. “If they want to be doctors, let them go to medical school” has been the American Medical Association’s mantra in spite of the fact nurse practitioners have never claimed that they wanted to be doctors.

What disturbs me is Dr. Jauhar’s focus on limiting NP practice at a time when our health care system has been shown to be inadequate. US life expectancy at birth, 71 years, is ranked 35th. Slovenia ranks 33rd. (WHO, 2013) We need to look at models where physicians, nurses, nurse practitioners, physician assistants and other health care workers can contribute their collective skills to deliver superior health services to all Americans. Rather than propose primary-care doctors get paid more and be designated the leader of the team, I would suggest he, along with the AMA, encourage the expansion of collaborative practice with the end result being accessible, cost effective and appropriate health care for all.

My letter didn’t get published. However, the ones that did and were supportive of nurse practitioners were authored by those more credentialed than I. They made excellent points in debunking Jauhar’s disparaging comments. And the 852 comments on line appearing over the next 17 days, until the comment section was closed, tipped in support of NP’s. (I didn’t check all 852 but did a sampling of the responses.)

Finally, let’s accept the fact that nurses are not doctors and don’t want to be and further agree to allow NP’s to practice “to the full extent of their education and training.”

Now let’s see if the New York Times publishes an essay from a nurse practitioner’s point of view.

COMPETITION

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.

NURSE PRACTITIONER VERSUS PHYSICIAN’S ASSISTANT

Last week in a restaurant in Lyon, France, my tablemate turned toward me and asked, “What’s the difference between a nurse practitioner and a physician assistant.”Lyon

My husband and I were on a tour. Our traveling buddies consisted of older folks like ourselves. The woman knew I was a retired NP and had told me she frequently saw either an NP or PA when she went for routine medical appointments. She was satisfied with either but didn’t know the difference.

I became an NP in the early 80s and worked in Chicago when NPs were trying to expand our practice by gaining prescription privileges. We were much maligned by the traditional medical establishment. “If nurses want to act like doctors, let them go to medical school” or something to that effect seemed to be the mantra of the American Medical Association. (Both the AMA and the Illinois Medical Association are located in Chicago).

I, with other NP’s, worked in a not-for-profit clinic on the west side of Chicago, caring for the medically underserved. There were few general practice doctors in this part of the city—most set up offices in the more affluent sections. In spite of the fact we NPs were supplying an unmet need, better accomplished if we could prescribe necessary medications, we were seen as competition.

Physicians counteracted the influx of NPs by cultivating their own homegrown subordinates: the physicians’ assistant. I, for one, thought the PA mimicked the doctor’s role in treating illness and didn’t take into consideration the broader aspects of patient needs: physical, mental, psychosocial, economic and functional ability. Aha, we all have some prejudices at one time or another.

As I dipped my crusty baguette into the last bits of a creamy Mornay sauce on my plate, I debated how to answer. Now here was an opening for me to tout the superiority of NP’s.baguettes

At first I did bore my table companion a bit by describing educational paths and state requirements of each profession. But then, remembering the many PA’s I had worked with over the years, I said, “There really is little difference. Both want you to stay healthy and independent.”