Nurse practitioners vs. doctors: A medical turf war?

by Kathryn Serkes and Derek Dye
Founder, Executive Director, Doctor Patient Medical Association, and my comments (all of which are parenthetical and in blue font).

 Some characterize the latest showdown between nurse practitioners and physicians in Pennsylvania, Michigan, Massachusetts, New Jersey, California, and Texas as a turf war — a medical fight like the farmers versus ranchers.

(Wrong! It is like a master craftsman versus a first year apprentice. Who do you want building your cabinets?)


Legislatures in those states are considering bills that would allow nurse practitioners, or NPs, to treat patients without direct physician supervision. NPs are nurses with advanced training beyond that of RNs – most have a Master’s degree and a one-year internship. (Oh, wow, so much training! A full year! I had 13 years of training and I am still not omniscient — the goal for which all we “non-smart physicians” strive).


So are some doctors resisting because of ego, coupled with just a plain old stubborn resistance to change? Or is it a genuine concern for their patients?

(Duh! It is the latter, and if one has to ask the question, then they do not know anything about how physicians are selected — because they are! More importantly up until now, you got to choose who was going to see you or your loved one, but not any more! 

A person doesn’t just wake up one day and say, “I am going to become a pediatrician today.” It takes 4 years of college, four years of medical school, and 1 to 13 years of internship, residency and maybe a fellowship or two. On top of that there is constant study of the medical literature — personally I average 2 hours per day — on top of formal Continuing Medical Education that is required by the state in which one practices medicine).

And many doctors fear that the use of NPs and other “physician extenders” — a term they resent for its implication that doctors’ unique skills can be magically transferred to mid-level practitioners (subterfuge, these people are novices) – is the first step down the slippery slope to “replace” doctors with cheaper, less-skilled professionals in the relentless pursuit of lower cost (…voila! you have Obamadoesn’tCare, but it will be neither cheaper nor as good — more subterfuge for the useful idiots).

There are also practical reasons for their anxiety. Physicians Practice columnist James Doulgeris points out that most doctors don’t have the time or tools to effectively manage mid-level clinicians (“Mid-level” is a euphemism for apprentice) and they (doctors – mater craftsmen)  rightly worry about assuming the liability for NPs who practice under their supervision – a potential cash cow for litigation-happy lawyers (lawyers, by-the-way, who put Obama into office).

But smart doctors are figuring out that allowing NPs to practice what they are trained to do can be good for patients. (Yes, all the dumb doctors who resist this government-driven takeover are not smart — but they are master craftsmen!).

“Docs have to wake up to the reality that the role of primary care must change, and get the tools to become team leaders,” says Nicholas Bonvincino, M.D., and VP of MDClick, an innovator in doctor-run, patient-centered medical homes. (Good old Nick here is making a fortune by getting reimbursed for high-level care but using low-level care from apprentices. How? By cheating on quality and following the new rules of Obamadoesn’tCare. Yes comrade, you will be paying more and getting less. Can you say useful idiots? You better, because if you voted for this socialism, then you are one). 

Does that mean the “dumbing down” of medicine for patients? Not at all. Instead it allows NPs to practice at the top of their skills, and frees up the doctors to handle the more complex and difficult cases that play to their strengths. (Subterfuge! It means that you are paying for Steak but getting Jack-in-the-Box. Of course, if you are a useful idiot, then there is nothing to see here). 

For example, employing NPs in nursing homes would minimize those patients’ trips to the ER, often for slight changes in condition. This would save billions and keep ER resources free for those needing emergent care.

There aren’t enough doctors. As DC reports, only one-fourth of California counties meet federal guidelines for the number of primary care docs. And demand is about to explode with Obamacare. Insurance isn’t much good if you can’t get actual care.

Given the choice of no doctor or a NP when you have a sick child — a common dilemma for the underserved and Medicaid patients (Subterfuge! All one has to do is take the child to any hospital and they, by force of law, are to care for that child regardless of pay) – most parents will choose the NP (Subterfuge, in reality they get to see an ER doctor. Yes, with socialized medicine the people your “sick child” will see are going to be acting like they are masters when they are novices. Hey, but its your kid, so you choose. Oh, sorry; this is socialized medicine, you don’t get to choose anymore)!

 But there is an even more convincing argument to be made for changing the paradigm of primary care:

 Americans love convenience. (Yes, but not when your loved one is at stake Jack)!

 (just an aside…I was listening to ReachMD — a Sirius radio station intended for doctors — and they were talking about the condition known as “multiple myeloma.”  One of the treatments is a bone marrow transplant, and as of today, if you are in America, then the cutoff age for getting a bone marrow transplant is age 75; okay, this is ageism, but in Canada and Great Britain the cutoff age is 65! That is absolutely frightening unless you are a socialist, and both the host and the expert commentator just walked on by this prejudice!

 My great aunt lived to be 108 years old. Now think about that for a minute…And these socialists are the same bunch of doctors who are going to be establishing and running Obamadoesn’tCare…Just thought you should know)