How I would end the war between nurse practitioners and doctors

One of the more contentious topics on my site is the scope of practice for non-physician providers, such as nurse practitioners.  This echos the debate on the national stage where leaders of physician organizations, who want to protect their scope of practice, conflict with those of nurse practitioners’, who want to perform the tasks that physicians traditionally have.

Simply Google “nurse practitioner” on this site, for instance, and you’ll see what I mean.

So the results of a recent New England Journal of Medicine survey comes as no surprise.

According to the study,

… nurse practitioners were more likely than physicians to believe that they should lead medical homes, be allowed hospital admitting privileges, and be paid equally for the same clinical services. When asked whether they agreed with the statement that physicians provide a higher-quality examination and consultation than do nurse practitioners during the same type of primary care visit, 66.1% of physicians agreed and 75.3% of nurse practitioners disagreed.

And that’s a problem, considering these two groups will soon be working together in patient-centered medical homes, the supposed future of primary care.  Most nurse practitioners believe they are qualified to lead them.  Physicians disagree.

The president-elect of the American Academy of Family Physicians makes it clear: “Family physicians work with nurse practitioners across the country. They are critical players on the health care team — but they are not physicians. A physician-led patient-centered medical home ensures we have the health care professionals we need and that every patient gets the right care from the right medical professional at the right time.”

Given the shortage of primary care doctors, we should give nurse practitioners the opportunity to earn the responsibilities of physicians.  But how can we ensure that the differences in training (physicians receive almost four times as many hours) doesn’t impact patient care?

Unify primary care certification.  Make anyone who wants the responsibilities of a physician and leads a medical home, doctor or nurse, pass the same test.

Consider the Doctor of Osteopathy.  Osteopathy is still viewed with suspicion by some, like this writer at Forbes who says, “osteopathy started out as little more than pseudoscience,” and that, “students enrolling at colleges of osteopathy have lower grades than students entering medical schools, suggesting (though this is not proof, of course) that D.O. schools provide an alternative route to a medical degree for those who aren’t good enough to get into normal medical schools.”

But despite the differences in training, osteopaths have generally been viewed by both the medical community and the public as equal to allopathic physicians.  Why? Osteopaths have to pass the same exams MDs do in order to be board certified.

According to the NEJM survey, most nurse practitioners want to lead medical homes, admit patients, and receive the same pay for performing similar clinical services as doctors.  And given the shortage of primary care clinicians, they should be given the chance to.

Require primary care doctors and nurse practitioners to pass the same certification test. In the eyes of some doctors, this will “legitimize” the ability of nurse practitioners to lead medical homes.  And nurse practitioners who pass this hypothetical test can finally receive the physician responsibilities they want.

Everybody wins.

Kevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor,, also on FacebookTwitterGoogle+, and LinkedIn.

View 86 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories