In speaking with our family and friends, we have found that the vast majority are either not aware of the problem with nurse practitioner (NP) independent practice or are not quite sure what to do about it. We hope this article will provide you, our patients and families, with concrete facts and information to spur real action.

The Problem

Vast Educational Differences

Physician education and Nurse Practitioner education are vastly different:

  • Physician education and training is highly regulated, standardized, and rigorous, with many years of formal assessment and evaluation.
  • Nurse Practitioner (NP) education rigor and quality has sharply declined in recent years.  NP education can be nearly 100% online, with near 100% acceptance rates, and with little or no prior RN experience.  Even the pioneer of the Doctor of Nursing Practice (DNP) degree,  Mary Mudinger, admits that NPs are delinquent in core competency areas.

Unnecessary Referrals and Overuse of Testing by NPs

Nurse Practitioners are more likely to order referrals, imaging tests, and laboratory exams that patients do not need.

Faulty Research Claims

Nurse Practitioner leadership consistently states that “50 years of research” shows NPs to be equal to or better than physicians in patient management.  The problem is the these studies are poorly done, and often have improper and unsupported conclusions.

Rural Access Claims are False

The NP lobby claims that NPs “need” independent practice to serve the rural population.  This is false on two counts:

  1. There is no state law currently in place that limits where an NP can practice, whether independently or not.  Nurse Practitioners in any state can go practice in rural areas right now with no new law required.
  2. In states where NPs already have independent practice, NPs do not go to rural areas at any greater rate than physicians do.  Nurse Practitioners have already legislated themselves into independent practice in 23 states, and they are concentrated in urban and suburban areas in every one of those states.

Why You Should Care

You Could Lose Your Physician

When Nurse Practitioners gain independent practice, the team is no longer intact. You may not receive physician-led care.

You May Not Even Have a Choice Anymore

When NPs gain independent practice, hospitals and practices are no longer motivated to pay for higher levels of care. You may go to an ER and be forced to see only a Nurse Practitioner, even if you want to request a physician.  You may not even have the option to see a physician in many places, as hospitals are actively replacing physicians in Emergency Departments, Urgent Cares, and even within the hospital for your inpatient care.

You Don’t Pay Less When You See a Nurse Practitioner, and You Might Pay More

When you see a NP, your insurance copayment is the same as when you see a physician.  Your out-of-pocket cost is the same, whether you get to see your physician or not.

When you see an NP, you may have an unnecessary referral (another NP or a physician) or undergo unnecessary testing, which adds cost to your care.  Many referrals made by NPs are for things that could be managed by a Family Medicine Physician without a referral.

The patients affected most are those who are economically or geographically disadvantaged, worsening already existing health disparities.

What You Can Do

  • Email and/or call your legislators and tell them your concerns.  You can include some of the evidence from this blog by cutting and pasting the links.
  • Share information with your family and friends. You can find us on Facebook and Twitter.
  • Ask for physician-led care, every time.
  • If you’ve been affected by mismanagement by a NP, please report it to us and consider sharing your story with a journalist.  We can help you do this, if you like.
  • Ask your healthcare practitioner about their training. Every “doctor” isn’t necessarily a physician.  Physicians want to share with you the rigor and sacrifices they’ve made to ensure you receive the best care and will gladly share their background with you.

Additional Reading
AMA’s brief on physician-led care
OpEd on why NP independent practice isn’t the solution
Use our physician mapper to find a physician-led care team near you! New physicians are added regularly!