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This is an interesting question for me. Mostly, because while internists and internal medicine residents will state a clear difference, rightly so, they mostly have a collegial relationship with NPs. They often work in the same offices, and will see one another's patients. And yet, we have similar nurses in our field who practice independently and are vehemently opposed to the idea of working anywhere near an anesthesiologist. They don't want to consult with them when questions arise, and they surely don't want to share patients. What's the difference?
Studies have shown for a long-time now that NPs provide good care in the clinical setting. Here's just some evidence of the abundance that exists:
Mundinger, M.O., Kane, R. L., Lenz, E.R., Totten, A.M., Wei-Yann, T., Cleary, P.D., Friedewald, W. T., Siu, A. L., Shelanski, M.L. (2000) Primary care outcomes in patients treated by nurse practitioners or physicians. JAMA. 283(1): 59-68.
Aigner, M.J., Drew, S. & Phipps, J. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioner/physicians versus physicians only. J Am Med Dir Assoc. 5 (1):16-23
Lenz, E.R., Mundinger, M., Kane, R.L., Hopkins, S.C. & Lin, S.X. (2004). Primary Care outcomes in patients treated by nurse practitioners or physicians: two year follow up. Medical Care Research and Review. 61(3): 332-351.
Litaker, D., Mion,L., Planavsky, L., Kippes, C., Mehta, N. & Frolkis, J. (2003) Physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care. J Interprof Care. (17(3):223-237.
Now consider this. With the abundance of evidence of exists stating no differences in outcome, call your local physicians office and see how long it takes you to get an appt. with the physician. Now ask to see the NP. Any difference? Outside of the most rural areas where there might not even be a physician, my guess is that it'll take you longer to see the physician. In some areas, much longer. I'm talking months, not just days or weeks.
My point is that the public, for some reason or another, will wait months to see the physician, even when they can pop in to see the NP within a week. And yet there is so much evidence out there saying there's no difference. Do you and I believe there's no difference? Of course not! My family and I will only be seen by physicians. Not because I don't personally like nurses, quite the contrary, I have many great friends in the field of nursing. I simply respect the educational process of becoming a physician, the years of sacrifice, and most importantly, their vast knowledge base. If I have a medical problem, I want to know what it is, how to treat it, and almost just as important to me, I want to know what it's not. From my experience, a physician is innately qualified to develop a wide differential, quickly and efficiently narrow their focus to the most likely culprit, and figure it out. This isn't always the case of course, but given the choice, I'll wait to see the physician. And I'm obviously not alone!
And here we arrive at a crossroads in our own field. Do I believe there's a difference in outcomes between nursing and physician level anesthesia care. I most certainly do. I believe there's a difference in length of hospital stay, morbidity, and mortality. But billing data won't reveal the differences. And where I train, nurses do general cases and ASA 1 and 2 patients. Billing data doesn't give ASA status. Here, nurses don't do any complicated cases, and they really have no desire from my discussions with them. They don't do regional. Tell me, how are you going to conduct a solid study, while at the same time giving informed consent to patient? You simply cannot.
If the public chooses nursing care, like at times they choose to see the NP, I'm okay with that. But that needs to be an informed decision. Right now, it's simply not. I see the AANA lying about equivalence in training and I read editorials distorting the truth about nurses and MDs in our field having the same length and quality of training. It's on the shoulders of the ASA to inform the public. It's their duty as our representative organization. It should not be up to the public to sift through the vile and anger between the AANA and ASA to find the truth, but for the most part, as far as I can tell, it's mostly the AANA that has been doing the talking. The public hasn't had a choice in what to believe.
If, in the end, the public is informed and has a choice, like they do in IM, and choose nursing-level care, then I'm fine with that. But it really needs to be an informed decision. The American public deserves that. But, they need to recognize also that my care is available. The care of a physician and all that it entails. But really, we need to level the playing field of accurate information before that choice can be made.
Studies have shown for a long-time now that NPs provide good care in the clinical setting. Here's just some evidence of the abundance that exists:
Mundinger, M.O., Kane, R. L., Lenz, E.R., Totten, A.M., Wei-Yann, T., Cleary, P.D., Friedewald, W. T., Siu, A. L., Shelanski, M.L. (2000) Primary care outcomes in patients treated by nurse practitioners or physicians. JAMA. 283(1): 59-68.
Aigner, M.J., Drew, S. & Phipps, J. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioner/physicians versus physicians only. J Am Med Dir Assoc. 5 (1):16-23
Lenz, E.R., Mundinger, M., Kane, R.L., Hopkins, S.C. & Lin, S.X. (2004). Primary Care outcomes in patients treated by nurse practitioners or physicians: two year follow up. Medical Care Research and Review. 61(3): 332-351.
Litaker, D., Mion,L., Planavsky, L., Kippes, C., Mehta, N. & Frolkis, J. (2003) Physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care. J Interprof Care. (17(3):223-237.
Now consider this. With the abundance of evidence of exists stating no differences in outcome, call your local physicians office and see how long it takes you to get an appt. with the physician. Now ask to see the NP. Any difference? Outside of the most rural areas where there might not even be a physician, my guess is that it'll take you longer to see the physician. In some areas, much longer. I'm talking months, not just days or weeks.
My point is that the public, for some reason or another, will wait months to see the physician, even when they can pop in to see the NP within a week. And yet there is so much evidence out there saying there's no difference. Do you and I believe there's no difference? Of course not! My family and I will only be seen by physicians. Not because I don't personally like nurses, quite the contrary, I have many great friends in the field of nursing. I simply respect the educational process of becoming a physician, the years of sacrifice, and most importantly, their vast knowledge base. If I have a medical problem, I want to know what it is, how to treat it, and almost just as important to me, I want to know what it's not. From my experience, a physician is innately qualified to develop a wide differential, quickly and efficiently narrow their focus to the most likely culprit, and figure it out. This isn't always the case of course, but given the choice, I'll wait to see the physician. And I'm obviously not alone!
And here we arrive at a crossroads in our own field. Do I believe there's a difference in outcomes between nursing and physician level anesthesia care. I most certainly do. I believe there's a difference in length of hospital stay, morbidity, and mortality. But billing data won't reveal the differences. And where I train, nurses do general cases and ASA 1 and 2 patients. Billing data doesn't give ASA status. Here, nurses don't do any complicated cases, and they really have no desire from my discussions with them. They don't do regional. Tell me, how are you going to conduct a solid study, while at the same time giving informed consent to patient? You simply cannot.
If the public chooses nursing care, like at times they choose to see the NP, I'm okay with that. But that needs to be an informed decision. Right now, it's simply not. I see the AANA lying about equivalence in training and I read editorials distorting the truth about nurses and MDs in our field having the same length and quality of training. It's on the shoulders of the ASA to inform the public. It's their duty as our representative organization. It should not be up to the public to sift through the vile and anger between the AANA and ASA to find the truth, but for the most part, as far as I can tell, it's mostly the AANA that has been doing the talking. The public hasn't had a choice in what to believe.
If, in the end, the public is informed and has a choice, like they do in IM, and choose nursing-level care, then I'm fine with that. But it really needs to be an informed decision. The American public deserves that. But, they need to recognize also that my care is available. The care of a physician and all that it entails. But really, we need to level the playing field of accurate information before that choice can be made.
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