Advanced NP

[Dr. Pedo]

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I've posted in Family medicine as well, but I'm interested in what they are telling you in mschool about this......


I recently came across this situation in my residency for Pediatric Dentistry. I asked a parent who they use for their primary physician; she responded with Ms. X an advanced nurse practitioner and a board-certified family nurse practitioner. I looked it up and she has an independent office and she claims to provide the same care for children and adults as a family doctor. Including but not limited to: physicals, ob-gyn, RXs, laser-hair reduction.

I'm having to contact her regarding the little one's SBE coverage for a pathological heart murmur and I feel like I should have a MD/DOs input---obviously I'll be contacting the Cardio for review of the echo cardio-----but I typically enjoy having the added confidence of being able to call the primary anytime--am I crazy here! Is this a new thing-----I thought the NP needed to have direct supervision from an MD/DO. I think this is a scary development and I'm all for nurses but they cannot and should not be practicing outside of their educational parameters. What is the inside information that I'm missing?

 

[njbmd]

I've posted in Family medicine as well, but I'm interested in what they are telling you in mschool about this......


I recently came across this situation in my residency for Pediatric Dentistry. I asked a parent who they use for their primary physician; she responded with Ms. X an advanced nurse practitioner and a board-certified family nurse practitioner. I looked it up and she has an independent office and she claims to provide the same care for children and adults as a family doctor. Including but not limited to: physicals, ob-gyn, RXs, laser-hair reduction.

I'm having to contact her regarding the little one's SBE coverage for a pathological heart murmur and I feel like I should have a MD/DOs input---obviously I'll be contacting the Cardio for review of the echo cardio-----but I typically enjoy having the added confidence of being able to call the primary anytime--am I crazy here! Is this a new thing-----I thought the NP needed to have direct supervision from an MD/DO. I think this is a scary development and I'm all for nurses but they cannot and should not be practicing outside of their educational parameters. What is the inside information that I'm missing?

Hi there,
If you wish to know the scope of practice of a NP in your state, contact your State Board of Medicine and the State Board of Nursing. They are the final word in how practicioners may advertise and practice.

njbmd 🙂

 

[trudub]

Yep, in some states that is perfectly legit and I would consider it within their scope of practice. However, state to state regulation varies when it comes to PA's and NP's.

 

[coureurdubois]

I believe Nurse Practitioners can practice with limited or very limited physician supervision in most states. In all states they can prescribe medication. In almost every state this includes narcotics. Insurance companies are making increasing use of NPs in the first tier of medical care. And consider that an RN can become an NP in a year or two of graduate school work (often the tuition paid for by the hospital where the RN is employed).

 

[greets fr. nyc]

In terms of the health care economic crisis these days, I think that NP are a positive development (less expensive / same type of overall service?). Also, people want choice in this country and they should get it.

It remains to be seen whether they are better served medically and emotionally by a NP. Some people would feel uncomfortable seeing a NP, while others wouldn't mind at all. To each his/her own. Goes to show that clearly state legislatures feel that it doesn't doesn't take a researcher/sub-specialist to do primary care... (i say this facetiously, and with all due respect to amazing people who choose to do primary care (MDs), which there are fewer and fewer).

 

[CruiseLover]

Nurse practitioners also provide cost effective care for your practice as a primary doctor. I am friends with a women's health nurse practitioner and she sees normal annuals, STD testing, prenatal education, routine OB checks, contraceptive prescriptions, etc. This frees up the physician for high risk patients, surgical patients, procedures, etc. Nurse practitioners carry much less malpractice costs. They also make approximately $60,000 - $70,000 in the midwest. This is clearly less than physicians. Patients typically love their visits with the NP because they are longer, with more education. This improves the public relations of your practice, also.

The key to a great NP is getting one who knows his/her limits. When the care becomes complex, it is co-managed or turned over to the physician. For instance, if an arrythmia is found, a cardiologist is consulted. Therefore, if you need to speak with the NP, she will have all of the patient's records and will be able to converse with you appropriately.

 

[Dr. Pedo]

Thanks for the responses; just another learning experience for me---thanks again.

 

[MacGyver]

Hi there,
If you wish to know the scope of practice of a NP in your state, contact your State Board of Medicine and the State Board of Nursing. They are the final word in how practicioners may advertise and practice.

njbmd 🙂

Actually in most states the medical board has zero control over NPs. NPs are regulated by nursing boards and MDs have no say in what they do

 

[MacGyver]

Nurse practitioners also provide cost effective care for your practice as a primary doctor. I am friends with a women's health nurse practitioner and she sees normal annuals, STD testing, prenatal education, routine OB checks, contraceptive prescriptions, etc. This frees up the physician for high risk patients, surgical patients, procedures, etc.

Primary care doctors dont do "high risk" patients or surgery unless they are on the only doctor in the whole county.

High risk patients are controleld by specialists, not primary care docs.

So what you are really saying is that the NP can do everything that you as a primary care doctor can do. That must make you pretty mad, considering you spent a fortune on an education that an NP paid much less for.

 

[tigress]

Primary care doctors dont do "high risk" patients or surgery unless they are on the only doctor in the whole county.

High risk patients are controleld by specialists, not primary care docs.

So what you are really saying is that the NP can do everything that you as a primary care doctor can do. That must make you pretty mad, considering you spent a fortune on an education that an NP paid much less for.

I think the poster was referring to an OB/GYN, who are often considered primary care practitioners, and do in fact see high risk OB patients and do surgery. In that context the post makes sense, in that the NP cannot do everything the OB/GYN physician can do, but can see routine patients.