Us Vs. Them

For the complete background on the NP role (as seen through the MD lens) read the following:



http://www.acponline.org/advocacy/where_we_stand/policy/np_pc.pdf



This is a position paper by the American College of Physicians on the Use of Nurse Practitioners. Embedded within are all of the insecurities that ACP has about NPs 'encroaching' on physicians work. They repeatedly state that MDs have more extensive training (I don't think anyone in the NP world argues this point, but the MD side constantly states this) and that NPs should not be seen as a way to replace physicians.



I see this as a lot of double talk. The article acknowledges that very few med students go into primary care which is how the NP role sprang to life, along with PA's in the 1960's. It goes on to say that NPs provide an invaluable service in rural areas and areas where medical needs exceed demand. Then it also says that the NPs shouldn't be replacing physicians and that they should merely be an adjunct to the MD. They also seem to say about a dozen times, that NPs should not practice beyond their scope, but then they also go on to say that NPs can meet 60-90% of needs in primary care so it would seem that they are acknowledging that primary care is within the scope of the NP's practice, right after they fretted about NPs practicing beyond their scope.

They state how patients that have NPs may have better outcomes than when they see the MD, but then go on to poke holes in the study that found this to be true. They state that NPs are nursing and MDs are medicine and that they are practicing two different arts and that certification exams should be drawn from each background, but yet state that they are not opposed to a NP centered health care team in addition to the physician centered one but that the NP team must be held to the same standards as the MD centered team although they are quick to say in other parts of the paper that NPs and MDs are different animals. If they are truly so different, why should the same standards be used to measure the success of the NP led team?



As early as 2012, the DNP certifying exam could be a close relative of the US Medical Licensing Exam, which could show the MDs that NPs can also pass the exam. Needless to say the AMA and ACP both do not want NPs sitting for the MD medicail licensing exam since some MDs have long held the belief that once NPs take the same certifying exams that MDs take, they will be treated as true colleagues. With this possibility approaching, the AMA and the ACP have put out position statements saying that nurses should not be taking a medical licensing exam, they should be taking a nursing licensing exam. One could theorize that the AMA and ACP are afraid of the success rate of NPs taking a medical licensing exam so they oppose the use of 'their' test.



All of these leads me to believe they are running scared and noticing that Medicaid is recognizing the NP as a primary care provider (there is a new bill now which would require Medicaid to reimburse NPs and PAs at the full rate instead of at 85% of the MD rate), more and more retail clinics are opening up, and most primary care offices employ NPs. Now there is a possibility that NPs will be able to sit for a similar exam to the medical licensing exam.



With position statements like these, it's hard for me to not take on an us vs. them mentality, statements like these put people on the defense...or at least it puts me on the defense.