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Saturday, April 23, 2011

What's the Difference Between a Doctor and a Nurse Practitioner?

A lot of heated debate surrounds the issue of NP vs. MD. As expected, nurses support advanced nursing practice, physicians scaffold the alike. Moreover, one encounters stigma of a nurse practitioner being “Oh, is that 'under' a doctor?” But nurse practitioners function as independent health care providers and succeed in the areas where the physicians lack time, training, experience, or desire to practice.
First, non-physician providers (both NPs and PAs) have historically thrived in settings where physicians were unavailable - places they were unable or unwilling to go. For example, UMass Medical School has special incentives for physicians to join practices in the Berkshires, an area remote from any major city. In the same area, NPs open successful practices, where they provide care to a large segment of the population. Nurse practitioners accept positions in university clinics, which most of the physicians decline because they are not lucrative. This is not always the case, and across the country, nurse practitioners and family physicians work together in practices where their skills complement each other.
Second, most NPs focus on disease prevention and health maintenance as well as patient education.  On the other hand, the medical model of healthcare tends to focus on the diagnosis and treatment of disease. The nursing model is more holistic; it incorporates the treatment of the human response to disease and emphasizes the prevention of disease. For example, consider a patient who receives tube feedings at home.  A nurse practitioner is likely to assess patient’s nutritional intake, daily routine and social life limitations due to the presence of a tube, body image, family relationships, identify support systems, and so on in addition to trying to identify pathology.
According to the AANP, more people chose NPs because "they provide individualized care, focusing not only on health problems, but also on the effects health problems have on people and their families; they explain the details of health problems, medications and other topics to help people fully understand how to take care of themselves; and they ask about people's worries and concerns about their health and their health care." Nurses consider caring as a major component of nurse-patient interactions. Nurses are more likely to incorporate empathy and compassion in the care. Nurses are trained to educate patients in the language that patients can easily understand, while physicians are famous for spilling terminology-filled waterfall of information on their patients within a matter of minutes. 
As good as all of the above sounds, an advanced practice nurse may not always meet some of the client needs that a physician does. Nurse practitioners lack the amount of education and training compared to the four years of medical school and three years of residency that the physicians hold.  Due to this fact, nurse practitioner’s scope of practice is narrower than that of a physician. Some believe that nurse practitioners are likely to order more tests and consultations and be quicker to admit patients to the hospital, thereby driving up health care costs. I am not sure if I completely agree with this statement, because a good NP works in collaboration with the physician and seeks advice or approval when ordering additional testing.
For many years, federal and state reimbursement policies limited the care NPs could provide by placing restrictions on the coverage of their services. In 1992, the Balanced Budget Act was passed, which changed the situation. With the BBA in effect, Medicare coverage of nurse practitioner services became liberalized. Medicare once limited coverage to services performed in rural areas and nursing facilities; now nurse practitioners may receive direct Medicare reimbursement regardless of the place of service.
People ask me all the time if I am going to become a doctor or if I wish I became one. I always answer, "No. This is who I am, and I help patients in ways that doctors don't." With the introduction of a Doctorate of Nursing Practice, a nurses is no longer a physician's helper.

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