Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MD vs NP: Principles for a civil online discourse

John Schumann, MD, Anna Reisman, MD, and Matthew Freeman, DNP, MPH
Physician
September 15, 2013
196 Shares
Share
Tweet
Share

For busy and opinionated physicians, online comments are both catharsis and a form of self-expression. After all, doctors are in the thick of it. We see how policies affect our patients. We know how politics affect our profession. While traditional editorials require time, editing, and an editor’s decision to publish the piece, online comments provide an easy and instantaneous way for even the most overworked and harried physicians to vent publicly. Seeing one’s opinion stream smoothly from brain to fingertips to computer screen feels good.

It is miraculously simple, but it can be problematic. Amid the stresses of patient care in an increasingly complex health care system, the temptation to unleash anger online can be hard to resist. Making sure our voices resonate with equanimity, with professionalism, with decorum, respect, and tolerance takes work.

In some online discussions, the voices have become ugly.

The highly charged scope-of-practice debate. Consider the debate about whether nurse practitioners should be able to practice independently. Kevin Pho regularly features posts by and about NPs. Like bees to nectar, a post on the topic is sure to draw dozens of anonymous, hate-filled comments. As Pauline Chen related recently in the New York Times, there’s a sizeable gulf between doctors’ and nurses’ assessments of the training, skills and abilities of NPs.

That’s putting it mildly.

When one of us wrote an article advocating independence for nurse practitioners, a reader (a doctoral-trained nurse practitioner) responded via email — an articulate, smart, knowledgeable, and witty response that not only illuminated one nurse practitioner’s perspective, but offered a glimpse into the nurse practitioner alternative universe that physicians know so little about. The correspondence inspired the reader to add to the public conversation by writing his own advocacy piece.

Within hours of his posting, there was so much hate speech directed at him — including a complaint sent directly to the president of the university where he works — that he feared for his safety. He had the piece taken down, effectively silencing himself.

It’s not hard to understand that some doctors feel directly threatened by nurse practitioners seeking to practice to the full extent of their education. “How,” some primary care doctors ask, “can someone with significantly less training, and very different training, do the same work as well as we do?” Many commenters (both physicians and other readers) cite anecdotes, perhaps unwittingly overlooking the canon of research demonstrating equal or better patient outcomes between physicians and nurse practitioners. Anecdotes can be a reasonable springboard for meaningful dialogue but they cannot be the only source of data. An angry anecdote is the lowest form of evidence; not surprisingly, responses may be divisive and escalating.

Change is occurring so quickly in American health care that many physicians feel that they are drowning. Disabused of their hopes for higher social status and struggling to keep their practices afloat, primary care physicians labor to adapt to each transformation of health care delivery. Even medical organizations like the American Medical Association and the American Academy of Family Practice that preach collaboration among specialties draw a line at welcoming nurse practitioners as partners rather than subordinates.

If nothing else, doctors and nurse practitioners can surely agree that sniping about characteristics inherent in different professions – professions that share end goals – is counterproductive. Progress can’t happen in a context of disheartening, rude, and sometimes appalling comments. Such vitriol empowers and encourages similar animus in comments from non-physicians. This can legitimize public misperceptions of nurse practitioners and validate physicians’ claims.

Both professions are held to the highest ethical standards in society. If professionalism is truly a core value and competency of physicians and nurses, then we need to practice what we preach. Act professionally. Appreciate other viewpoints as an opportunity to learn. Invite nurse practitioners to the table. Welcome their efforts to improve the health of the nation. And, most importantly, work together for the good of our patients.

Physicians and nurse practitioners can agree to disagree while keeping it civil. The art of listening, after all, is a cornerstone of both medicine and nursing.

Bullying is never the answer.

Principles for a civil online discourse 

The etiquette of online commenting is unusual in that much of the time people add to the conversation and do not return. Occasionally, of course, voluminous dialogue ensues. Here are a few suggestions for keeping online comments civil:

  • Anecdotes are fine, but avoid drawing generalizations from one story. (“We had that dumb NP once. She didn’t know where the gallbladder is located. So NPs must all be dumb.”)
  • Identify the underlying emotion of a comment that irks you, and name it when you respond. (“Doctor Strangelove, it sounds like you’re frustrated that NPs have fewer hours of training and are asking for the same salary as MDs. Here’s my take: ….”)
  • Name-calling is out. Polite, respectful comments are more likely to be taken seriously, and to stimulate a productive conversation. ( “SJ, I appreciate hearing your viewpoint. Here is WHY I disagree with you.”)
  • Own your comments. Instead of making broad generalizations, make it clear that you are offering your opinion. (Rather than saying, “NPs simply should not be practicing without some sort of physician supervision,” say “I don’t think NPs should practice without any physician supervision.”)
  • Consider phrasing your comment in the form of a question. (“I’m troubled by the thought of NPs working in a rural area with no access to collaborating physicians. Does anyone have experience with that?”)
  • Go for the win-win. (“The demographics, economics and politics of health care reform suggest there’s enough pie for all of us in the primary care world. We are all undervalued and overworked. By uniting in cause and working with each other, both groups stand to gain in terms of creativity, relationships, and (dare we say) income.”)
  • Find the best alternative to a negotiated agreement (known as “BATNA” — taken from the classic tome, Getting to Yes). (“NPs are here to stay, with increasing autonomy across more and more states. Let’s find a way to work together — whether you’re a doctor or NP, our end goals are the same.”)

John Schumann is an internal medicine physician who blogs at GlassHospital. Anna Reisman is an internal medicine physician who contributes to Slate. She can be reached on Twitter @annareisman. Matthew Freeman is a nurse practitioner.  This article was originally published in Health Affairs.

Prev

The difference between health care and disease management

September 14, 2013 Kevin 9
…
Next

AMA: The administrative burden of being a physician

September 15, 2013 Kevin 3
…

Tagged as: Primary Care

Post navigation

< Previous Post
The difference between health care and disease management
Next Post >
AMA: The administrative burden of being a physician

More in Physician

  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

    Katrina Gipson, MD, MPH
  • Beyond the disease: the power of empathy in health care

    Nana Dadzie Ghansah, MD
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
  • Recent Posts

    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 136 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Sam Neill's Rare Lymphoma
  • Day in the Life of a Doctor: Treating a Patient With Septic Shock
  • Paxlovid May Lower Long COVID Risk, VA Study Suggests
  • Digital Inhalers May Improve Uncontrolled Asthma Management
  • Another Win for Zolbetuximab in Advanced Gastric/GEJ Cancer

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
  • Recent Posts

    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

MD vs NP: Principles for a civil online discourse
136 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...