I have worked with some great nurse practitioners (NPs) who I consider to be friends. They play a vital role in team-based practice. This is not about NP bashing. Nor is it a turf war; now that I’m retired, I have no turf to protect. I am a member of Physicians for Patient Protection out of real concern for the future of medicine in this country.
I want there to be physicians caring for my family and me as well as for my former patients. The corporatization of health care that treats everyone as interchangeable widgets doesn’t care whether those caring for you actually have the appropriate training. Medicine is complicated. Doctors aren’t perfect. They are human and make mistakes. But the odds of a mistake are far less when the education and training foundation of those providing medical care is greater.
Expertise can’t be acquired by online training. We are not interchangeable professions. Nursing is nursing and medicine is medicine. Our professions are complementary, and patients benefit when we work together. The independent practice of medicine by nurse practitioners is a folly that is leading to patient harm. One should be truly concerned about programs with acceptance rates in excess of 70 percent. Some have 100 percent acceptance rates. (By contrast, undergraduate acceptance at the University of Texas at Austin is 40 percent, Harvard is 6 percent. The overall acceptance rates for the 118 U.S. medical schools in 2016-17 was 5.8 percent.)
To think we can solve a physician shortage by training more nurses to step in is saying that the professions are the same. How comfortable would you be if the next time you had travel plans, your airline announced that due to a pilot shortage, they were substituting an aeronautical engineer to fly your plane? He has a PhD and knows a lot about the science of flight. But being a pilot requires different training. So too in medicine. Nursing training is not medicine. Many health issues are self-limiting and will resolve no matter who treats them. Many issues are lifestyle issues that nurses excel at dealing with. But knowing when a complaint is not a minor problem can be challenging, and so working as a team is what best serves the patient. It’s time for physicians to take back medicine. Our biggest mistake was allowing the corporate practice of medicine. While we were busy caring for patients, the ranks of hospital administrators swelled.
People who crunch numbers but have no knowledge of medicine tell doctors how many patients they can see, how fast they must be seen, and how and with what they can treat the patients. I remember as a youngster watching Dr. Kildare, Ben Casey and Marcus Welby, MD. I never saw any of them on the phone with an insurance company asking permission to order a lab test, imaging study or surgery. Dr. Welby had time to visit with his patients and establish relationships. Those were the ideals that led me into medicine and which drove many of my colleagues. It is time that doctors take back our profession. And it is time that nurses were rewarded for being excellent bedside nurses instead of being urged by their leadership to acquire meaningless online degrees that are not improving health care but are lining the pockets of the for-profit diploma mill industry.
There was a time when skilled professional bedside nurses played a vital role in the care of hospital patients. They were the eyes and ears of the doctor. Many were the times I responded to their call, that nothing specific was wrong, but the patient just didn’t seem right. The baby wasn’t taking its bottle the same, or the adult patient just didn’t seem himself. These nurses who had spent years at their jobs had a sixth sense and knew their patients. But those skills are no longer rewarded, and the only way for career advancement is through clinical ladders advocating advanced degrees that do not improve clinical skills. Administrators have determined that the bedside interactions could better be done by less skilled (less expensive employees) leaving nurses who entered the field wanting to help people, instead of stuck in front of computer screens. Long gone are the days when a change of shift meant the oncoming nurse and the one going off duty stood at a patient’s bedside and reviewed the patient’s status, wound condition, mental status, etc. in conversation with the patient.
Now, the nurse going off duty leaves a recording for her replacement who must ascertain what was meant by things like “the wound looks OK with just a little drainage,” or the “the patient is a bit sleepy.” We have replaced their human interaction with technology, making the jobs less rewarding, and then told them that the way to advancement is through more degrees which can be obtained online while still working their regular RN shift since they’re already on the computer. And now, nursing leadership with the support of bean counters tells them that while they are still in nursing school that there is a fast track to become a “doctor” without the bothersome necessity of going to medical school or even bothering to practice as an RN.
It is time for all of us to start working together for the well-being of patients.
Patricia Anne Aronin is a neurosurgeon.
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