Both nurse practitioners (NP) and physicians embrace the concept of “Do no harm” yet cannot seem to support and respect one another.

It’s Just Inflammatory

In 2017, an op-ed was posted on a social media network by a physician that was provocative about NPs:

Nurse practitioners are not, I repeat, not physicians. They lack education, IQ, and clinical experience. There is no depth of clinical understanding. They are useful but only as minions. Not politically correct, but true. Who would you want your family member seen by—a nurse or a physician?” —Doximity.com, 10/2017

One’s initial response may be to get angry after reviewing that. Yet, instead of remaining angry, perhaps the use of emotional intelligence and research could be of more benefit with analyses of the social media post.

A Little History Lesson

In 1965, Henry Silver and Loretta Ford, a physician and a nurse, developed the first training program for NPs. The course of instruction focused on disease prevention, health promotion, and was in direct response to a national shortage of primary care physicians of that time. The deficit was especially concerning in rural, urban, and undeserved communities. This sounds eerily similar to current health care accessibility issues of today. Ford and Silver met much opposition with the development of the first formal program for NPs.

Surprisingly, the opposition was not only from physicians but also nurses. Some claim nurses believed that the title of “Nurse Practitioner” would be deceptive and somehow damage the nursing profession; meanwhile, it is believed that some physicians felt that NPs simply did not have the skills to take care of the public health needs without supervision (e.g., oversight). What is captivating, however, is how a nurse and a physician identified a need and were able to work in concert to try to address the concern.

The Un-Packaging

“Nurse practitioners are not, I repeat, not physicians.”

Merriam-Webster defines a physician as: “A person skilled in the art of healing.” Thus, this could be considered offensive to a physician who has gone to school for many years and has done an average of 10,000-15,000 hours of clinical rotation. In contrast, the NP goes to school for many years too but only averages 600-1,200 clinical hours. Humbly, if one is being honest, the sheer number of clinical hours that physicians do may suggest their training is better. Does that mean that they are superior? It should stand to reason that if one’s course of study includes more hours that their training is superior, but this does not mean that a NP is not essential in their own right. Therefore, it is understood that a NP is not a physician.

They lack education, IQ, and clinical experience. There is no depth of clinical understanding. They are useful but only as minions. Not politically correct, but true.”

It has been documented that IQ tests do not test intelligence but can simply demonstrate that one is a good “test taker.” Hence, one should understand that having a high IQ does not constitute knowledge, nor is the IQ the only predictor for one’s success. The language used in the op-ed may be viewed as crude to some and offensive to others; however, if one could look past the words and get to the root of what was being said it might be helpful. Checking egos at the door and realizing that medicine is not a power structure—it should simply be patient-centered. As such, there may be some value to the thought that NPs need oversight to practice.

What’s wrong with collaboration, anyway? This should be viewed as a valuable tool that assists with the care and safety of patients who may not otherwise have access to adequate health care. This should not degrade the NP’s worth but prove valuable for the public.

For those arguing about NPs and their worthiness—are they willing to work in rural, urban, and undeserved areas? Who does this argument really hurt? To meet the current health care demands, there would need to be a tremendous supply of willing physicians. Where are they? Additionally, some studies imply women and children suffer the most in medically underserved areas, Who will serve them? Is that physician you?

“Who would you want your family member seen by—a nurse or a physician?”

Qualifications and experiences are probably the central reasons for patients preferring a provider no matter what their title. But physicians may be more often preferred for their skills, whereas NPs may be favored for their social skill and ability.

Maybe fear, lack of confidence, and overwhelming need as a NP to validate worth could make them seem unworthy. But this should not be confused with lack of skills or professionalism of the NP. Oversight should not indicate a servant-to-leader relationship but rather a teamwork concept to support and respect one another. One cannot reasonably argue with the number of hours of study a physician puts in—it is commendable. Having said that, this does not belittle the course of study for the NP, either.

Physicians and NPs are all valuable, and working together can be nothing but good for all around. So, in the words of Rodney King, “Can’t we all get along?” Let’s work together in concert to direct a beautiful symphony called safe patient health care.

Regina G. Goldwire, FNP-BC

Regina G. Goldwire, FNP-BC, is a veteran and a nurse practitioner who loves medicine.

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